Q. I also have BPD. I e-mailed you before and your answers helped. Thanks! Now, I have this terrible desire to cut myself. I usually utilize a razor blade but now I've discovered that knives go deeper. It helps me feel real. I regret it later but I hate myself so much. I feel so alone like no one understands. I started this behavior in July and now it's December and it's like an obsession to me.

I also need to know if you can die if you take too many Trazodone w/alcohol. I'm not sure about my whole existence. I attend therapy weekly but the pain is so hard. One hour a week doesn't help me deal with the other million hours that I have to live. You need to know that I'm a perfectionist. I also have OCD. I feel like I can't meet people's expectations of me....work, my husband, and especially my alcoholic father. What the hell does love mean anyway?

A. I hope you are on medication. With OCD and BPD you should be on either Zoloft, Effexor, or Prozac. Take enough until your mood swings go away, carbohydrate craving goes away, and cutting goes away. This would be 200 or more of Zoloft, 300-450 of Effexor XR, and 80 mg or more of Prozac. I have published on all of these treatment modalities.

Killing yourself would be a tragedy. The "thought" you have of death is not really a thought. Deciding if what I tell you is true is a thought. You can weigh the pros and cons and decide if it is valid or not. Suicidal thoughts are automatic, like a fever with a flu or high sugar in diabetes. You have no choice, so they are not really thoughts. Hurting or killing yourself would be a tragedy. Get on the right meds and enough to work.

Cutting is also part of the illness. People with BPD do it because it makes them feel better. Once you get enough medication in you, it will go away quickly. Drinking with BPD is common, but a bad thing because the alcohol tends to disinhibit and depress folks. Avoid overdosing and get treatment with medications. Psychotherapy alone is not very effective, but is great in combination with the right medications.