Q. I have been diagnosed with BPD and my therapist thinks I may have ADD also (not hyperactive type though.) My problem is this: I am 26 years old and I am dealing with doctors who only treat adults. I hear voices sometimes when I am stressed. As soon as I mention that every doctor I have seen is quick to put me on anti-psychotics. I have been on Risperdal, Mellaril, Haldol, triavil, and Zyprexa, none of which has done any good at all (the voices are pretty rare anyway.) They claim that the problem with my concentration is due to psychotic symptoms. Neither I, nor my therapist believe this is the case. I think one of the problems is that because I wasn't diagnose as a child with ADD, that the doctors, for some reason, won't even accept that as possibility. As I said above, my therapist thinks I may have it because of the symptoms I have discussed with her...

My therapist has spoken to the people I have tried to speak to about ADD and she thinks that a big problem is that they really don't know much about BPD among other things. Anyway, she spoke to the Nurse, who I saw last and was able to educate her a little about BPD. (I recently moved and am being forced to start over with new doctors and therapist.) Unfortunately she was a fill in nurse and will not be following my case. In about a month I will see my "real" doctor (instead of fill-ins) for the first time and I would like to speak to him about a possibility of ADD. However, I fear the same obstacles will be in my way.

Can you please help me? I would like to know what I can say to my doctor about BPD (and the voices I occasionally hear) and my concentration problems to help them to see that they are not due to psychotic symptoms (they pre-date the voices, I first heard them when I was 19 years old, the concentration has been a problem since my childhood.) It seems no matter what I say, once I mention voices, here come the anti-psychotics.

  A. If you do indeed have borderline personality disorder (BPD), the ADD is also a symptom of your illness. I think a more reasonable way to handle it, besides getting a doctor that knows about BPD, is to let them know you have long-standing concentration problems, stress-related brief psychotic episodes, and need help. Let them know that antipsychotics have been all but useless for you, and that something is needed. Usually, antidepressants resolve both the BPD and ADD a reasonable amount (see the scores of letters in the archives of this site). If augmentation is needed, stimulants like Dexedrine, Cylert, and Ritalin do not seem to help much. We have had better luck with Provigil as of late.