Q. I realized today as I cut that the scars have always got to be bright red. They've got to show the pain. I'm in so much pain so much of the time. I can't handle my emotions at all. I'm either totally numb or my emotions are off the wall. I never feel a little anything. I can't cry either. God, how I wish I could cry. I haven't cried since November 1996. That's three years without any release. I've been active in therapy since December 1992, but I've been self-injuring as long as I can remember. I'm ashamed to talk to anybody about it. I live in Florida, yet I wear long sleeves year round. I just tell people that I'm always cold. I take Zoloft, Ativan, Tegretol, Risperdal and Trazodone. My liver is shot, yet my mind needs these drugs. Before I got on my medications, I spent three years in bed. I showered once a week. Everything seemed so overwhelming. I must admit that I am doing better now. I just wish that I could overcome things like black and white thinking. I'm very pessimistical. I love my husband dearly but I can't stand to live with him. I crave his attention when he's gone to work, but when he's at home I stay in a separate part of the house. I can't handle being around people more that about an hour, then I want to be alone. Yet I can't stand to be alone. It's so damn insane! It's really hard to have relationships. I'm sure you've heard all of this before, but I had to get it off of my chest.

A. In all our studies on BPD, self-injury is the best prognosticator for outcome. The Tegretol you are taking may be reducing your antidepressant levels some. You may want to have your doctor measure your Zoloft (sertraline) level. It needs to be >180 ng/ml 6-8 hours after your morning dosage of medication. Most people need between 200 and 400 mg/day to get to this level. If you get it up to this level, and it is not working, you should consider Serzone (500 to 750 at bedtime) if you have no obsessive compulsive symptoms, or Effexor at 300-450 of the XR if you do. All of these dosages have been used in BPD studies published in peer reviewed journals.