Adderall and uBPD

[Guts42]

My wife is uBPD.  I'll spare the rehash but after reading "Eggshells" I'm fairly certain it's either BPD or NPD (actually I suspect she has BPD and her mother is NPD).  I've spoken with my therapist and my children's therapist (all of whom my W wants to fire...) and they suspect BPD as well.  It was my therapist who suggested I read Eggshells in the first place.

My uBPDw is convinced that all of what ails her can be attributed to ADHD.  For weeks she's been 'researching' and since her initial suspicions she's been slowly presenting more and more ADHD 'symptoms.'

She just had a 40 minute session with a new psychiatrist via telemed.
The doctor "officially diagnosed" her ADHD in this single session and is writing a prescription for Adderall.  She does see a therapist regularly who (according to my wife) also suspects ADHD...

I am concerned.  Does anyone have any experience or stories about BPD and Adderall?  The children's therapist was deeply concerned when I mentioned my wife was seeking Adderall.

[stolencrumbs]

My wife is uBPD.  I'll spare the rehash but after reading "Eggshells" I'm fairly certain it's either BPD or NPD (actually I suspect she has BPD and her mother is NPD).  I've spoken with my therapist and my children's therapist (all of whom my W wants to fire...) and they suspect BPD as well.  It was my therapist who suggested I read Eggshells in the first place.

My uBPDw is convinced that all of what ails her can be attributed to ADHD.  For weeks she's been 'researching' and since her initial suspicions she's been slowly presenting more and more ADHD 'symptoms.'

She just had a 40 minute session with a new psychiatrist via telemed.
The doctor "officially diagnosed" her ADHD in this single session and is writing a prescription for Adderall.  She does see a therapist regularly who (according to my wife) also suspects ADHD...

I am concerned.  Does anyone have any experience or stories about BPD and Adderall?  The children's therapist was deeply concerned when I mentioned my wife was seeking Adderall.

My stbxw is diagnosed with both ADHD and BPD (and anxiety and depression). I can give you a bit of my experience with it. First, I'll say that I do think my wife is ADHD. One thing to keep in mind is that adult ADHD in women can manifest in different ways, and in ways that don't line up with the common view of ADHD. And I think it's probably rare that a person with BPD doesn't have other comorbidities. So I wouldn't dismiss the ADHD diagnosis.

As for Adderall, my wife has taken it since I've known her--almost twenty years. I don't think that by itself, or when taken as directed, it's been a problem. But pwBPD aren't known for following directions or not being impulsive or not taking risks. My wife rarely took it as directed. She would stop taking it for a while, then start taking two or three times more than prescribed for a few weeks. That would lead to not sleeping, which was a much bigger problem. Then that would lead to taking various sleeping pills and/or drinking, then more Adderall because of the crash, wash, rinse, repeat. It was a bad cycle. In "good" times when she was taking it regularly and as prescribed, I think it helped. But the good times never lasted, and bad times on speed can be especially bad.

[GaGrl]

There are various forms of Adult ADHD. My son is Adult ADHD with lack of concentration, some impulsivity, and no hyperactivity. He also has a low level of depression and social phobia.

Several weeks to be the prescription of choice for Adult ADHD. My son doesn't like the way it affects him and refuses to take it. Vyanse has been an alternative for him.

It's very tempting to want a pill to solve a medical problem. It's the easiest solution. Plus ADHD does not hold the stigma that a personality disorder holds.our

What is your wife's goals for treatment? Has she expressed goals?

[Notwendy]

I don't think it's unusual for therapists to come up with a different diagnosis than BPD. For one, a person can pull themselves together for an 40 minute session and twist their story to fit several possible conditions. Also symptoms of these disorders can overlap. If she's been researching the condition, she also knows what symptoms to talk about.

 ADHD also seems to be a more acceptable diagnosis than some other disorders and so she may prefer that label.

Your children's therapist may be concerned about possible abuse of the drug, as it has that potential.

My (wild)guess is that she won't like the effects of the Adderall. The way it works I don't think it helps with anxiety or emotions. If it's BPD, Adderall is not likely to work on the emotional issues.

Although I understand your concern, this is something out of your control. Your wife can see a doctor, say what she wants, and probably get some kind of medicine for it. The responsibility for prescribing the Adderall is on the therapist.

One reason the therapist may have agreed to try it is that it works pretty quickly and so the T will know if it's helping or not.  Some medicines like antidepressants take weeks to see an effect. This may be a trial.

[Guts42]

Thanks all!
So I agree - I think ADHD is likely in the mix but not the root of her issues.  She denies, or at least hasn't mentioned to me, any possibility of a PD.  That's my concern.

She has a history of pill abuse (mostly things like vicodin and Xanax with alcohol) but that was before I knew her and what she assigns to part of her college years.

My wife hasn't expressed any goals other than to not be so "nervous and scared" anymore.  She attributes her anxiety to her previously undiagnosed ADHD and that once she's on Adderall and that's in check, everything else will simply fall in line.

Like NotWendy said, I suspect she won't like how Adderall feels.  She has panic attacks when she takes a full dose of Sudafed.  She likes to self medicate and often changes care providers that don't give her what she says she needs.  (For example she's looking for a new doctor* now because our current doc wouldn't give her antibiotics without an in person visit)

She has a followup with the new psychiatrist in about a week.

I think you might be right, NotWendy, this may just be a trial... a little diagnosis by treatment.

*this will be her 3rd or 4th primary care doc in less than two years.  My wife convinced me, nearly, that our last doctor was trying to slowly drive her crazy by prescribing wrong dosages and supplements while trying to seduce me.

[Notwendy]

I don't want to burst your hopes, but I have watched this go on with my BPD mother for decades.

I believe the emotional pain is real and I feel sorry for her that she experiences that. One thing about BPD that is so frustrating is the denial/projection aspect. I think she really believes it's not her, it's everyone else. It's the bad doctor, or the misbehaving kids, or the _________________ thing she's projecting the source of her discomfort on to.

The hope is that, for the most part of my parents' marriage, little was known about BPD. Despite multiple mental health interventions, it wasn't possible to arrive at a diagnosis and treatment that nobody knew much about at the time. There is a lot more information now. But even now, it's a challenge for a therapist to come up with a diagnosis and treatment with a patient who may not be self aware or forthcoming about what is going on with them.

Sometimes the issues have to unfold in time. A therapist might suspect BPD behaviors but not be able to say it right away or know that if they did, the patient would just leave and they can't help at all. Either your wife's therapist is way off, or they are trying to arrive at BPD by first going with the issues she presented and then if they don't work, going in another direction. By that time, they will have seen her more than once and have a better idea of what's going on. Ultimately- if it's going to work at all, there needs to be some incentive on her part to work with it.

You have no control over this- it's between her and the therapist.

[Bluejay12]

We have particular experience with our BPD daughter and Adderal.  She took it as a teen and in college on the recommendation of pediatrician/ PMD at that time.  Made her extremely irritable and sent her into rages at times.  Now she’s married to an nPD and is completely isolated from all family as a result of her BPD and her crazy marriage to an nPD.  Two small children have to live in this very volatile household with ALL family disallowed from seeing the children.  Daughter works from home and husband sitting home not working.  Premie and 4yo in that household.  She’ll want the Adderal just to keep her job and her household responsibilities   Her BPD is worse than ever and there is certainly concern for the children who live in  this isolation.  A good therapist should be asking about your daily lives, lives of the children and social and familial connections that might help.  Maybe lightening the load will help with focusing and anxiety.