Q. I am a 17 year old female who has just found out that I'm in the developing stages of BPD. I never knew why I do the things I do, and now finally I have an answer. I haven't been diagnosed, but my doc says that I can change to where I will not have this illness. But how?? How can you change the way you've lived, your perspective of life if you've lived that way for so long? It seems impossible! I hate living this way and if I can stop it, I want to try to the best of my ability to stop it's path before it's too late, if it isn't already. Please help me... I don't have the faintest idea of even how to begin changing. One reason why I know I have to change is that my problem in BPD is promiscuity. I'm so very lucky that I haven't contracted a disease by now! Especially with all the risks that I have taken and the many partners I've had. It's so scary! Please give me some advice on how to begin the healing process of this horrible destructive path that I am on. I need all the support I can get.

A. My own personal bias is that BPD is a biological disease, like diabetes or hypertension or asthma. We have no idea what causes any of these, but know how to treat the syndromes in most cases of all of them. The best treatment for starters is biological. You need to be on a medication that will help with your illness. The choice depends on your symptoms, and how knowledgeable your doctor may be about BPD. Find a doctor you like and knows what they are doing. Then, find a medication that works and has as few side effects as possible since you will need to stay on it for the foreseeable future. Best bets for BPD pharmacotherapy are Effexor XR (450-600 mg/day), Zoloft (200- 400 mg/day), Serzone (500-750 mg at bed) or Prozac (80-120 mg/day).

Therapy is important, but should be done after you fix what is physically wrong with medications. Cognitive therapy is the way to go. My particular system utilizes rational emotive therapy (RET) as delineated by Albert Ellis, Ph.D. He has published a number of good books on RET, and you can pick most of them up at Borders-type bookstore places. Your observation that you cannot change as things stand is a super observation. Everything you are doing makes perfect sense based on your chemistry. Like a fever with the flu, you have no choice. Changing the chemistry will change your drives and give you the opportunity to make better choices.