Q. Dear Doctor

I searched Patty's site and didn't see this question addressed. Can a person have MPD/DID and BPD at the same time? Do you view them as mutually exclusive or do you view them as on a continuum? Can a person heal from both and go on to lead a successful life if they see a therapist and don't take medications? Is BPD always biologically based? Can a person with MPD/DID have many borderline characteristics/traits without the biological base (i.e.. can they be symptoms from the abuse)? Are most personality disorders biologically based or environment based (nature vs. nurture)? I've also been hearing how many folks with BPD are also diagnosed with ADD or 
ADHD, is this common? Is there some kind of relationship between BPD and ADD/ADHD (brain chemically speaking)? 

A. If someone is doing something they do not like, they stop if they can. People like to be warm in the winter, cool in the summer, and satiated when hungry. Therefore, they wear coats in the winter, shorts in the summer, and eat when hungry. To do something you do not like--feeling depressed, cutting yourself, arguing, fighting, etc.-- is out of context with how a person leads the rest of their life. We do not walk in shorts in the snow. We do not wear fur parkas in summer when it is 90 degrees. We do not go around hungry if food is available. If the painful experiences we suffer are under volitional control, we stop them.

I do not believe therapy alone will work as well as therapy and medications together. If BPD is biological, and all the data suggests it is, therapy alone would be like talking to diabetes to get the blood sugar down. If the chemistry of the illness gives rise to the behaviors that are disdainful, they cannot be stopped unless the chemistry is changed. Once the chemistry is better, than therapy works great, and is a form of therapy to fix social atrophy.