# Interesting theory regarding BPD



## KathyBatesel (Apr 26, 2012)

This link is to an article about a doc who claims to successfully treat BPD by treating it as a medical seizure disorder. I think it's an interesting and possible concept, but I haven't reviewed the doc's actual studies and findings yet. 

Borderline Personality Disorder: Raising Questions, Finding Answers


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## DayDream (May 25, 2011)

KathyBatesel said:


> This link is to an article about a doc who claims to successfully treat BPD by treating it as a medical seizure disorder. I think it's an interesting and possible concept, but I haven't reviewed the doc's actual studies and findings yet.
> 
> Borderline Personality Disorder: Raising Questions, Finding Answers


There could be something to that. I may be slightly BPD, runs in the family, and I suffer from manic depression and one of the drugs they give me is actually given to seizure patients to treat that.


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## KathyBatesel (Apr 26, 2012)

That's interesting. Have you found it helpful?


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## DayDream (May 25, 2011)

Very. I take it for anxiety.


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## KathyBatesel (Apr 26, 2012)

Good deal!


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## Uptown (Mar 27, 2010)

KathyBatesel said:


> This link is to an article about a doc who claims to successfully treat BPD by treating it as a medical seizure disorder.


Kathy, I also have found his claims to be interesting. Dr. Leland Heller has been advocating this approach for quite a while and says he has treated several thousand people in this manner. In 1999, his book _Biological Unhappiness_ was released in paper back. It makes the same claim about curing BPD. I find it concerning, however, that Heller has never persuaded a peer-reviewed psychiatric journal to publish his findings and claims.


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## anony2 (Apr 28, 2012)

From my understanding from the article mentioned below, they have known that some have non-epileptic seizures for a long time, but is this man saying something different than the article mentioned below?

"Psychogenic Nonepileptic Seizures
TAOUFIK M. ALSAADI, M.D., and ANNA VINTER MARQUEZ, M.D., University of California, Davis, Medical Center, Sacramento, California

Am Fam Physician. 2005 Sep 1;72(5):849-856.

Psychogenic nonepileptic seizures are episodes of movement, sensation, or behaviors that are similar to epileptic seizures but do not have a neurologic origin; rather, they are somatic manifestations of psychologic distress. Patients with psychogenic nonepileptic seizures frequently are misdiagnosed and treated for epilepsy. Video-electroencephalography monitoring is preferred for diagnosis.* From 5 to 10 percent of outpatient epilepsy patients and 20 to 40 percent of inpatient epilepsy patients have psychogenic nonepileptic seizures. These patients inevitably have comorbid psychiatric illnesses, most commonly depression, posttraumatic stress disorder, other dissociative and somatoform disorders, and personality pathology, especially borderline personality type.* Many patients have a history of sexual or physical abuse. Between 75 and 85 percent of patients with psychogenic nonepileptic seizures are women. Psychogenic nonepileptic seizures typically begin in young adulthood. Treatment involves discontinuation of antiepileptic drugs in patients without concurrent epilepsy and referral for appropriate psychiatric care. More studies are needed to determine the best treatment modalities.

Nonepileptic seizures are involuntary episodes of movement, sensation, or behaviors (e.g., vocalizations, crying, other expressions of emotion) that do not result from abnormal cortical discharges. The seizures can mimic any kind of epileptic seizure and thus can be mistaken for generalized tonicclonic seizure, absence seizure, and simple or complex partial seizures.1 Early recognition and appropriate treatment of nonepileptic seizures can prevent significant iatrogenic harm and may result in a better outcome."



Psychogenic Nonepileptic Seizures - September 1, 2005 - American Family Physician

It sounds to me this is an argument of which came first, the chicken or the egg.


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## KathyBatesel (Apr 26, 2012)

It sounds real similar, although "comorbid" means existing at the same time, while Heller seems to assert a cause/effect. 

Uptown makes an important point if Heller's not seeking peer-reviewed publications to put forth this theory.


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## Uptown (Mar 27, 2010)

KathyBatesel said:


> Heller seems to assert a cause/effect.


*One concern* I have about Heller, as I said above, is his lack of peer-reviewed publications.
*
A second concern,* as you note, is his claim of cause and effect. It has been known for nearly two decades that certain brain abnormalities (e.g., a reduction in the hippocampal and amydgala volumes) and certain chemical abnormalities are often found in BPDers. Yet, it also is known that such structures and processes are abnormal in persons subject to great stress. What remains unclear, then, is whether BPD is the RESULT of such abnormalities -- as Heller claims -- or, rather, simply the CAUSE of them. And, of course, there also is another possibility: that both the abnormalities and BPD are caused by a third, unidentified factor.
*
A third concern* is the incongruity between his claim, on the one hand, that BPD is a medical problem that can be cured, and -- on the other hand -- that BPD "is treatable with medication first and then by retraining the brain." See his BiologicalUnhappiness.com website. Indeed, the title of his book -- _Biological Unhappiness_ -- loudly shouts that the underlying problem is a biological one that is treatable with a pill. On closer inspection, however, we are told that the "pill" essentially calms the BPDer down so that therapy can work.

*A fourth concern* is the nature of that pill. The one he prescribes for most BPDers apparently is Prozac, an antidepressant. Yet, because a BPDer's issues go far beyond depression, there is no evidence Prozac will cure any part of it. My BPDer exW, for example, took antidepressants and did weekly therapy for 15 years -- all to no avail. With regard to antidepressants, Heller claims that_Prozac usually stops most of the mood swings in a few days. It is, in my opinion, as big a breakthrough for borderlines as insulin was for diabetics. _ See Dr. Leland M. Heller discusses the Borderline Personality Disorder (BPD) – Biological Unhappiness.​Really? My view as a layman is that Heller, who is an MD -- not a psychiatrist -- is confusing the "mood swings" typical of bipolar with BPD temper tantrums. IME, the vast majority of BPDers do not exhibit mood "swings" because their ten-second flips between _hating you_ and _loving you_ are instantaneous -- not a "swing" at all. These flips are event triggered -- not caused by gradual changes in body chemistry. 

Granted, about a third of BPDers nonetheless do exhibit "mood swings." But this is not due to the BPD traits. Rather, it occurs because they have bipolar in addition to BPD. A recent study (pub. 2008) found that a third of BPDers also suffer from bipolar disorder.

For low-functioning BPDers -- those with "severe symptoms" -- Heller says he prescribes neuroleptics like Haldol. Well, that is fine I suppose. But psychiatrists all over the country have been prescribing anti-depressants, anti-anxiety drugs, and even stronger medications for decades to BPDers -- without "curing" any of them. 

The hangup, of course, is the therapy needed for "retraining the brain," as Heller sometimes concedes. Although excellent therapy programs are available for learning to manage BPD traits (not cure them), it is rare for a BPDer to remain in therapy long enough to make a difference. And, even when they do -- as my exW did for 15 years at enormous cost to me -- they may choose to only play mind games with the therapist.

*A fifth concern* is the malpractice suit against Heller which apparently was settled in 2008 for about $200,000. See Dr. Leland Heller - Phone & Address Info - Okeechobee, FL - Family Practice. I don't know what to think about that because malpractice suits do not always mean the doctor provides bad treatment. It could mean, for example, that Heller was so committed to helping his BPDer patients that he was willing to risk his medical license by, say, prescribing a drug to be used in a way that has not yet been authorized. I don't know what happened.


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## pidge70 (Jan 17, 2011)

I have been put on every friggin AD under the sun and quite a few anxiety meds. I have also been put on Topamax in the past and Lithium. NONE of those drugs did a damn thing in regards to my BPD.


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## KathyBatesel (Apr 26, 2012)

Well, Uptown, you've done a great job of convincing me not to read further on Heller's theories!

Anony's link does seem to support the underlying theory, but after what Uptown's post uncovers it sounds like he's a bit flaky!


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## Uptown (Mar 27, 2010)

anony2 said:


> Is this man saying something different than the article mentioned below?


Anony, yes, I believe so. My understanding is that Heller is saying the opposite of what you found in that article. Heller believes that both bipolar disorder and BPD likely arise from epileptic seizures and, for that reason, he prescribes antiepileptic drugs (i.e., neuroleptics such as Haldol) to treat strong BPD traits. In contrast, the article you cite describes BPD as being associated with *nonepileptic *seizures and thus calls for the "discontinuation of antiepileptic drugs...." in BPD treatment.


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## anony2 (Apr 28, 2012)

Uptown said:


> Anony, yes, I believe so. *My understanding is that Heller is saying the opposite of what you found in that article*. Heller believes that both bipolar disorder and BPD likely arise from epileptic seizures and, for that reason, he prescribes antiepileptic drugs (i.e., neuroleptics such as Haldol) to treat strong BPD traits. In contrast, the article you cite describes BPD as being associated with *nonepileptic *seizures and thus calls for the "discontinuation of antiepileptic drugs...." in BPD treatment.


That is what I mean by chicken/egg, although as Kathy said the article is discussing co-morbidity. 

THIS:
"Haldol to treat strong BPD traits" 
Sure, it might treat them, but cure them? NO, I would not think Leland was on the right track with this, but I do not think that so called 'anti-depressants' are on the right track for people that are depressed either. lol


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