Q. I do understand that you can not diagnose me through the web, and I am not asking for a diagnosis simply some healthy advise.

In 1998 I was first diagnosed with Severe depression and in danger of committing suicide, I was admitted to a mental ward and since then I have been in and out of the ward, on medication and constantly in therapy of one type or other.

Recently my doctor diagnosed me with BPD in addition to depression, and I am really unhappy with that diagnosis. My doctor knows this since I am not known to withhold my opinions.

I am 28 year old female, I have had problems since I was a child, I was picked on at school and became isolated from other children my age. at about 10 years of age I started having suicidal thoughts. I did manage to get to University (Ethnology) but after 2 years I dropt out because of drinking (drinking is not a problem to day). I have tried to commit suicide a few times and will probably try it again (I am not in danger, this is not a threat). I am now out of work and on disability pay. I take Zoloft and Neurontin.

The thing is that I can agree that I may have a personality problem but I can not see that I fit the BPD criteria. I have been very cooperative to therapy and really put an effort to get my life back together, my doctor does congratulate on this. I am therefore very frustrated over this diagnosis and can not see that it will help.

I do have a very good relationship with my doctor and since I have been seeing him for over 1 1/2 year, he really is getting to know me and I am actually starting to trust him.

I do not see the world or people in black and white, to me people are more like animals neither good nor bad, just following their animalistic instincts and they can of course not be trusted since anyone will turn on you if it will suit him better (experience). Also I have only been in one steady relationship, it has lasted for 6 years, we have never had a major argument, I have never cheated on him and never walked out. I really do and have always loved him.

My friends consider me stable and a trusted reliable friend.

I do have mood swings during the day and have constant suicidal thoughts.

I am not impulsive except for the drinking which is now under control.

I hate rejection and respond in the extreme if I think someone close is going to reject me. But that may be a result from being rejected as a child.

I am consider strange, eccentric by all I meet, and I know that I am different, I think differently and respond differently from other people.

Sometimes I think that I am being followed by the police and that society wants to lock me away for ever because I am not human. It has been pointed out to me that this is not true.

Although I do realize that I have problems I just can not see how a person who has a trusted relationship with a man and friends can be a Borderline

The thing is that I find it more destructive to be diagnosed as a Borderline than something else. first of all it stays with you, I live in a country with a population of 280.000 people, ones known for something it stays with you, you really can't escape it.

An other thing is that my doctor builds the therapy on trust and I like that very much, the thing is if I think that I am losing control or in serious suicidal thoughts I need to be able to go to the emergency ward and get help, but the doctors there always react as if I am threatening or seeking negative attention, which is really not my intention. I am trying to be responsible, in spite the fact that I really would just go out in peace and quiet and hang myself instead of telling some complete stranger about it. I suspect they react this way because of the BPD diagnosis in my patients file.

How can I approach them under these circumstances with out being thought of as a naughty girl, but a responsible woman.

If you could give me any kind of guidance on how and in what direction I should continue therapy, or where I can find reliable information to help me I would be very grateful.

I really don't want to spend time and effort on BPD if it does not work.

I hope you can reply and please excuse the spelling and grammar English is not my first language.

  A. Your English is great, and the letter excellently written. I have told a number of people that a diagnosis really is irrelevant if you get better. If you are borderline, the diagnosis will help determine what kinds of medications and therapy to use. For example, borderlines tend to need more medication than simple depressives. In the case of Zoloft, we average about 325 mg/day in our borderlines (serum level of > 180 ng/ml drawn between 6 and 8 hours after the morning dosage of medication, where the entire dosage is taken in the morning). In our depressives, we use much less medication.

You cannot change what is already on the record, and truthfully, worrying about it will not help you. Getting better is your main goal, and all your efforts should go toward getting well. Long-standing depression or borderline personality are two difficult illnesses to treat. Whether you have either or both is irrelevant as something to worry about. It only matters to help with treatment.

My healthiest advice is to get on enough Zoloft (talk to your doctor about this), engage in therapy, and know that you will have good and bad days along the way. Keep yourself alive. You do have a biological illness, and the very fact that you currently have some days better than others means it is reversible (otherwise you would get worse or stay always at the same level of bad feeling). The illness is reversible, and you will get better. Do not worry over the diagnosis.