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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for borderline personality disorder

Answered by
Dr.
Dr. Alexander H. Sheppe

Psychiatrist

Practicing since :2014

Answered : 2242 Questions

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Posted on Mon, 6 Jun 2016 in General Health
Question: Hi, it's XXXXXXX You agreed to take me on as a private patient a while ago. As of Monday 4th April, I will be starting on the Promethazine I mentioned. I spoke to the surgery pharmacy who deals with my medication leading up to being put on it. I informed them that on from information I have found out about it so far, it is recommended that patients only take it as and when required, but because of the symptoms I will be taking for, I don't think taking it on a as and when basis is going to work for me or be beneficial for me, therefore could I have it added to my dosset box with all my other regularly taken medication.

They have agreed to do this. I picked up the dosset yesterday afternoon and they have prescribed it for 1 in the morning and one at night, which will make the dose 20mg as its a 10mg dose taken twice.

From the mental health doctor who has prescribed this has not referred me on to seeing anyone for support for any issues/concerns I have taking this, I wondered if you and I could have regular reviews/check-ins to review how I am getting on with it?

My mental health key worker, who incidentally I will be finishing working with in a couple of weeks has suggested that at the end of each day for about a month I write a journal of how each day has gone. Any unpleasant/struggling side effects I experience while my body system is getting used to it; and at the end of about a month, I take the journal to the doctor at the surgery and discuss everything with them. As when I go to the surgery, I don't know who I am going to see; in the nicest possible way, so I talk things through with someone consistent and who knows my case, can I also use you?

Sorry if I have rambled a bit, but given the type of symptoms that this medication will hopefully help me with, I am feeling quite anxious about starting it.

doctor
Answered by Dr. Alexander H. Sheppe 2 hours later
Brief Answer:
Private Consultation

Detailed Answer:
Hello XXXXXXX and thank you so much for using my direct private service. I now consider you my private patient and will do everything I can to help you.

I would of course be happy to help you discuss how you're feeling while taking this new medication. Write to me any time and we can talk about it. I can also help you discuss your case and concerns with other doctors if you'd ever like advice about that.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Alexander H. Sheppe 2 days later
I'm not happy with my surgery doctor. She is telling me that she might not refer me to a service/clinic as its not in the area
doctor
Answered by Dr. Alexander H. Sheppe 1 hour later
Brief Answer:
Private Followup

Detailed Answer:
Hello XXXXXXX

I'm sorry you're not happy with your surgeon. It's really unfortunate that this person is saying she might not refer you to an appropriate clinic. Even if there is not one close by, she does have a professional responsibility to help you find an appropriate place to follow up. I would politely but firmly say that you really need help, and she should respond with kindness.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Alexander H. Sheppe 40 hours later
I have realised that my head is constantly in two minds. One part of my head finds all the emotion/worry/anxiety/low mood/frustration/anger is emotionally exhausting. Yet the other part of my head thrives and even sometimes likes the drama in my life because for as long as I am experiencing these emotions I am keeping people supporting me/looking after me.

Also, I have admitted to my counsellor that I don't like being told I am improving/getting better; and that means they feel they can start working towards end working with them and I see them finishing working with me as them abandoning/rejecting me. I wondered if this is anything to do with Borderline Personality Disorder/Dependent Personality Disorder. Also, I just wanted to ask you what your understanding of the symptoms of BPD and DPD? I have read that DBT is successful treatment for personality disorder. Can this therapy be done/carried out online for free by any chance?
doctor
Answered by Dr. Alexander H. Sheppe 1 hour later
Brief Answer:
Private Followup

Detailed Answer:
Your description of you head being of two minds is actually a classic description of the experience of borderline personality disorder (and some related elements of DPD, but this is of secondary importance here). Another name which I personally like better for BPD is "emotional intensity disorder." As a result of a deep fear of abandonment, these patients feel emotions more intensely than other people. As you know, it can be very difficult to manage, as even as you are improving you fear the loss of the people around you. DBT is a very good treatment. However, it is not available online for free. DBT is an intensive psychotherapy with cognitive and behavioral components aimed to keep to you healthy. It requires a lot of in-person support by a trained therapist.

Dr. Sheppe
Above answer was peer-reviewed by : Dr. Naveen Kumar
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