Q. I have been hospitalized over 50 times during the past 10 years and am trying desperately to stop the cycle. Early in my treatment I was diagnosed with bipolar and borderline personality disorders. Until about 11 months ago, however, I was not informed of the borderline diagnosis. Over the past 10 years I have been treated with just about every medication available (including SSRI's, MAO's, mood stabilizers, anti-anxiety and anti-psychotic meds) with the goal of controlling my "bipolar" symptoms. Since none of those medication combinations worked, I was labeled a difficult patient who is not amenable to treatment.

About a year ago I was hospitalized (probated) in a state psychiatric institution and spent 2 1/2 months there. About a month into that hospital stay, I asked my doctor to discontinue all of my meds because they weren't working and I was suffering from severe side effects. To my surprise, he agreed. It was then that I was informed of my diagnosis of BPD. I have not been on medications or hospitalized since. 10 months is the longest I've gone without hospitalization in the past five years and I have never been without medications. As a result, I have begun to question the diagnosis of bipolar disorder and believe that the problem all along has been the Borderline diagnosis that everyone has swept under the carpet.

I have done a great deal of research about BPD since my last hospitalization and believe that I would benefit greatly from Dialectical Behavior Therapy. The problem, however, is that I cannot find anyone in my community (Cincinnati) who has been trained in DBT. I haven't even been able to find anyone who specializes in treating borderlines. As a result, I am not seeing a doctor or therapist at this point. My last doctor told me that I needed to have three years of stability (no hospital stays) before he would be willing to help me deal with my issues. I decided that this was not reasonable and know that I can't gain three years of stability without some kind of change in treatment. So, I decided to discontinue treatment and deal with my disorder on my own. I am sustaining in that I have maintained my job, paid my bills and all that stuff, but I still struggle a great deal with symptoms of borderline personality disorder. Most concerning is the intensity of my suicidal feelings at times. So, I know that not being in treatment is not a long term fix. I thought that I'd be able to find a psychiatrist or therapist who had been trained in DBT (Dialectical Behavior Therapy) or who at least specialized in treating borderlines.

Since I haven't been able to find such a person, I have three questions. One, do you know of anyone in the Cincinnati area who specializes in treating borderlines? Two, do you think it's is possible for someone to recover from this diagnosis without professional treatment? Three, do you have any recommendations for alternative approaches to meeting my needs?

A. I do not know anyone in Cincinnati who specializes in DBT, which is probably what you are asking about. Marsha Linehan invented DBT, and is in Seattle at the University. You may want to call her office for a reference. I do not believe you lose your BPD or can work it out per se, but do believe you learn better how to live with it. I feel BPD is biological/genetic in origin and requires medications. Unfortunately, medications do not work for everyone, and it may be you are better off with nothing, assuming you have been treated with the right medications at the right dosage.