Q. Our son has recently been diagnosed with BPD; he is 18. He is presently hospitalized. We know now that the signs of ADD and depression that began in middle school were either a prelude of this or that he wasn't properly diagnosed and certainly has been under treated. He's been in therapy, but we were told it's adolescence not a real problem. Now on approaching graduation and adulthood is completely overwhelmed. As I try to learn more I can't help but worry about the role we played in this. So many of the etiologies include that borderlines are products of environments where they were continually devalued and their beliefs were invalidated. He's the oldest of three and we can't understand this, but we also don't want to be in denial. My question is this:

Is it that due to the BPD his sensitivity was so acute or heightened that he perceived comments and play scenarios (that our 16 year old daughter describes as a wonderful childhood) as personal affronts and damaging?

Instances of play like being the "rotten egg" when young or sitting him down to do his homework because even as a young child he had little initiative of his own. These seem normal to us, not emotionally abusive.

Could it be that he has coped as best he could throughout these years with the help of the family and now his misperceived thought that he must face the world on his own is what has caused the severity of his problems?

This may sound so unimportant in the scheme of things, but we are suddenly faced with a child who we have done so much for to get him through school and to respect his "artsy" side, but who now is so angry at his father (he's split us for now). He says that his father was abusive, but the example that he uses (in uncontrollable anger and sadness) is that when he was told to do something like take out the dogs and he argued he was eventually just told "to do it". He says nothing was explained to him. It sounds so irrational when in the same conversation he will admit that he has never been a contributing member, never taken charge of his own responsibilities.

What can we do for him? He has no ability to plan for a job, to save money (it burns a hole in his pocket). His behaviors are so upsetting to his 11 year old brother and 16 year old sister. He's presently on Paxil 40mg and Risperdal 1mg. I think he'll be put on Depakote (sorry if the spelling is wrong) tomorrow.

Does he need parameters such as we have a rule that he can not pierce, tattoo or dye his hair dark colors until he is independent and on his own?(He shows his pierced nipples to his little brother). Or do we take the route that nothing is important as long as he isn't hurting himself or others? (that's been presented when he started cutting, but it's very hard on the others). We'd like him to address his issues with a goal of becoming independent not piercing instead of cutting. Is he capable of following moderate society rules?

  A. It is not your fault. You may have given him the genes, but it is very unlikely you taught him to be a borderline because of neglect or abuse. He is wired differently in his brain, and sees the world a different way. Trouble is, his way is so far off center that it is illogical. Worse, since he sees things so differently, he understands the world differently than you, and your explanations are meaningless to him.

Paxil is a horrible medication for BPD. He should be on Effexor or Serzone to maximize his chance of doing better. As with any disease, complete recovery is hoped for, but not always possible.