Diagnosis or no diagnosis at 17?

[superld]

My wife and I are convinced that our 17-year-old daughter has added most BPD traits for more than 3-4 years. She has been a very sensitive kid and struggles with peers at school early on. After several Inpatient treatments, including wilderness, five 5150s, half of a dozen therapists, a dozen medication tries, and IEP school adjustments, at 17, she is still struggling with depression and suicidal thoughts. Her high school decided that she could not stay at the school because of lack of attendance. She feels rejected and feel like a loser. She says "she is done with school and people". She has a top-notch therapist, but she is avoidant and refuses to do the real work. "She hates DBT". Her psychiatrist says that it's too early to diagnose her for BDP. The slimmer of hope is that she is attending the Family Therapy weekly and it feels that she is opening up a bit more. She is venting, and it seems to help a little.
Our question to the group is: would a BDP diagnosis at 17 help or hurt our daughter? The vast majority of professionals say that she is too young. A
minority (like MacLean Clinic) says that she can be diagnosed as a teen as long as she exhibits the traits for more than 1 year.

Our objective is to better understand the struggles our child faces and to learn the skills to improve our relationship and provide a supportive environment and also improve on our own emotional responses, attitudes and effectiveness as a family leaders

[Sancho]

Hi Superld
My opinion is that it is not a good idea - for several reasons.

The first is that at this point in time - and possibly for some time to come - a formal diagnosis of BPD would not make a difference in real terms. There is no specific medication other than symptom specific and it sounds as though these have been tried. It doesn't sound as though dd is ready to engage in DBT therapy. So it is difficult to see how a formal diagnosis could open a door to a positive step forward at this point in time.

Also it could have a negative effect. Some individuals may have other conditions that overlap with BPD and if a BPD diagnosis is given it can muddy the waters a bit for identification of these.

It is difficult to see our children suffering and we want so much to help them and guide them through the distress etc. You have clearly pulled out all stops to help your dd and put a support system around her. It sounds as though the thing that she is engaging with is the family therapy. It seems as though it is just a small thing, but sometimes a slow steady process is the means of change.

Given you can see signs of BPD I wonder if you explore the resources here and elsewhere in order to develop skills that support someone who has these signs - whether they are diagnosed or not. It can make an enormous difference if those around the person with these signs and symptoms are skilled in ways of interacting and supporting, know what boundaries to put in place and how to enforce them etc.

It is a challenging task to develop these skills but can be well worthwhile.

[zachira]

The position of many professionals with the credentials to diagnose a personality disorder is a person must be an adult before a personality disorder can be diagnosed because the personality is still being formed. Girls usually grow less than an inch after their first period and their adult personality is set much earlier than boys. Boys can grow until around 25 years of age and often are not mature until around age 25. Studies have shown that non mental health professionals are just as good at describing all the mental health symptoms as a mental health professional, except they usually do not know the professional terminology to describe what they are observing.

[superld]

Interestingly, my daughter appears to be a late bloomer. She grew one inch in the last year or so, and her teeth development seems behind. Her highly sensitive nature and experiences with bullying in school may explain some of her current conditions.

[livednlearned]

Maclean is where Blaise Aguirre is based, I think, and he's one of (if not the) leading experts on BPD in adolescence. In his book on BPD in Adolescence he writes that it makes little sense to wait until an age can determine a dx that has likely been persistently developing over time. BPD develops with the personality and the personality doesn't suddenly appear at age 18  

Part of the problem for clinicians is that it's harder to dx anything in kids. And it's hard to know how much of the environment is contributing to the behaviors, especially if there are stressors that are temporary.

There is also something going on with autism and BPD in young women. My stepdaughter (26) has been through a handful of diagnoses that include depression, anxiety, psychosis, bipolar, and now autism.

We're learning that autism in women looks different than what experts are calling "the Western white male model of ASD." For one, autistic women seem to be more driven to mask at a younger age.

Have you asked your D17 what it is she doesn't like about DBT?

[superld]

When we ask our daughter why "she hates DBT skills," she says, "I don't know."
She replies "I don't know" to any questions about her emotions.

[kells76]

Hey superid and welcome from me, too 

Like others have mentioned, there can be benefits and drawbacks to a pre-18 diagnosis. It seems like a benefit of diagnosis could be a clearer, straighter path to effective treatment. If your D17 is already in evidence based treatment then perhaps the diagnosis is less important at this point.

As long as her psych doesn't conclude "because it's too early to diagnose, then she shouldn't be doing DBT" (which it doesn't sound like her psych is doing), this seems like the least bad outcome.

Back when I was in treatment for an eating disorder as a teen (~16-18), family therapy was required. I remember lots of sessions where I would just dig my heels in and say "I don't know, I don't care" in response to questions. I didn't really understand myself at the time, but looking back now, I think it was actually a good thing -- I was pushing back against my parents in a therapeutic environment, kind of learning to assert myself. "No, I decide if I answer questions or not". That did not last forever! I don't remember the exact timeline, but over time, I engaged more in FT and would actually talk. If your D17 is saying things like "I don't know" or "I don't care", but is still participating in treatment, I'd call that a win. It might be developmentally appropriate, actually, for her to say those things right now.

And she may also be telling the truth -- she may not know what she feels or why.

Do you and your W ever have sessions with the FT without D17?

[Pook075]

In my daughter's case, multiple psychiatrists told us as early as 12 that we were dealing with rebellion on a mass scale and not mental illness.  By the mid-teens she was un-officially diagnosed bipolar and the BPD label came around 17.  However, a criteria for each of them (at least in my state) was being 18 years old.  Several other labels have been discussed as well and I am personally glad she wasn't officially diagnosed.

Looking back, these labels devastated my daughter at first, but they quickly shifted to excuses.  For instance, it's not her fault she tried to choke her sister to death or throw her through a sliding glass window, she's mentally ill.  It wasn't her fault setting the house on fire either, because her mental illness made her love fire.  I'm just bringing these up to say that the diagnosis was not helpful at all and for a time, enabled bad behavior which we were completely unequipped to deal with.

However, the biggest thing I realized in our journey is that nothing helps until my daughter actually wants to change.  That happened around around 23 after a series of heartbreaks, she finally wanted help and to turn her life around.  We went through hell up until that point, and I do realize that we're fortunate for her to accept therapy that early in life.  But it really came down to us cutting her out of our lives completely and letting her live with her own mistakes and consequences. 

It broke my heart but it was the right thing to do.

In your situation, you are powerless to force your child to want to change.  BPD is unhealthy inner feelings and emotions, meaning it's very personal to those affected.  What we can do is find different ways to communicate, to stop enabling, and to stop invalidating.  That makes a huge difference, but the biggest part of the journey is within for the person affected.

[CC43]

Super, I can relate to many interesting points on this thread.

As for a formal diagnosis, my opinion is that holding off on getting one is probably wise.  Treatments have already been recommended for your daughter (family therapy and DBT), which is what would happen with a BPD diagnosis anyway.  And she's still young.  Her personality might still be changing.  By not having a formal diagnosis, she avoids any semblance of stigma, and she avoids having a convenient excuse for misbehavior.  Once my stepdaughter had a formal diagnosis of BPD, I think she might have felt more hopeless than ever, as she didn't agree with it initially.  I also think she used illness as an excuse to avoid things like being nice to others, working and attending school.  It was like she had a free pass to be on a permanent vacation, which might sound fun at first, but it only made things worse for her and those around her.

As for therapy, I agree that it doesn't help much unless the patient wants to change.  But if your daughter is attending therapy sessions, I think that is a good sign.  My stepdaughter had a tendency to skip her therapy sessions at first.  And family therapy is key in my opinion.  Parents are her chief allies in turning things around.

"I don't know" is the phrase I most often hear from my diagnosed stepdaughter.  For superficial things, my stepdaughter will say "I don't know" as an avoidance tactic.  She is a queen of avoidance, evading anything that is a little stressful or requires a little responsibility.  She doesn't like to commit to anything, because that would mean obligation.  So "I don't know" is a convenient answer, to a dinner invitation or when asking for her input on the menu.  "I don't know" is also a conversation ender--she signals that she wants to be left alone.  And for more profound personal questions, like "What sort of work would you like to do in the future?  What do you consider your strengths are?  What do you like to do in your free time?--I don't know is the typical answer.  I believe that my stepdaughter doesn't really know who she is (except perhaps for considering herself a victim).  Once I did a strengths- and interests-finder test for a job hunt alongside her, and I couldn't believe some of her answers to the survey questions, including her old standby, I don't know.  She professed interests in things that I had never seen her take any interest in before, and she seemed to be clueless about her own strengths.  (For example, she didn't recognize her considerable artistic talents, but she said she liked math.  Minutes later, she couldn't figure out how to annualize her monthly rent to compare it to average starting salaries).  Anyway, I see the "I don't know" statement as a sign of ambivalence:  mixed feelings and contradictory thoughts about herself which are just too complicated and burdensome to put into words.  Maybe the ambivalence relates to the typical black-and-white thinking characteristic of BPD, and shifting from black to white to black again leaves her confused and uncertain about herself.
 

[Maggie EF]

This is a great discussion. There is a lot of wisdom in these posts. I have an undiagnosed 17-year-old daughter (uD17) who has been displaying BPD symptoms since uD17 was about 12 as well. uD17 is convinced she has DID, and one expert has already told us that she doesn't have it. uD17 has also convinced herself that she has fibromyalgia, seizures, and OCD. She is in treatment for OCD now, but the seizures stopped once we got the results from the neurologist that she has not had any seizures. We bought her a cane for the fibromyalgia, but it appears she only has it when she goes to group therapy. That being said, as soon as her OCD is more manageable, we will start psychological testing. If she is diagnosed or not isn't my main concern, right now my main concern is that she has a good therapist and group programs with kids her age that are struggling with similar issues so she doesn't feel alone.  All of this is helping her. She went to a facility once for crying wolf. She said that she took pills, but we found all the pills. It was too late to stop the 51/50, so she spent three days in-patient, and she hated it. They were very mean to her, and we feared for her safety. Since she got out of the facility, she has not given us a hard time with therapy.