I've been exactly where you are.  My daughter's diagnoses have been all over the place since around 13.  She has been in multiple RTFs, PHPs, IOPs and been kicked out of many of those. She has been inpatient in hospital behavioral health units dozens of times.  She's been diagnosed with bipolar, complex trauma, depression, anxiety, ADHD, and substance abuse disorder at different times. To make matters more difficult, the state in which I live does not allow release of information to parents for patients 13 years or older without a signed ROI consent.  This was not helpful in helping her get appropriate treatment as she did not wish to share this information.  I don't want to scare you, every kid is different.  Maybe I can help with what I wish I had done differently.

My ex-wife and I shared custody of my daughter and she spent time equally with both of us until about the age of 15 when she moved in with me full time. Even though we were fairly adept at co-parenting, my ex-wife and I couldn't seem to get on the same page with respect to boundaries. That is critically important and something I wish we had spent far more time discussing. Both myself and my ex-wife caved in to demands far too often to maintain our own sense of sanity, but it was counterproductive in retrospect.

Pay particular attention to what healthcare professionals are saying and if something doesn't sound right to you, ask for more information and bring up historical diagnoses. Almost every clinician knowledgeable with BPD has told me that these patients are typically not going to get better with just pharmaceutical intervention. SSRIs, for example, don't help BPD. That should be saved for short-term comorbidities such as depression, anxiety, etc...

This may be controversial, but I feel RTFs, PHPs, and IOPs were just stopgaps to ease the transition back from acute crisis. My daughter could write a book alongside Marsha Linehan on DBT, but she can't seem to employ those skills when it matters. It almost feels like RTFs, PHPs, IOPs are a (welcome) respite service. No shame in that.  The concern is that they get used to the crisis>stepdown process and come to rely on it for emotional regulation. My daughter did and does.

When my daughter is sober, working, in therapy, and has a structured schedule with supports - she does well.  When left to her own devices, she does not do well.  When she feels better, she convinces herself that she is past her mental health issues. She went from screaming for independence at 13, to begging for support now. I am doing my best to transition her to independent living and it has been a challenge.  She's been successful for months at a time and she's of the age now where it's critically important that safety nets are mostly removed. It's very important for both her and her family to have her be accountable for the natural consequences of her actions.

I wish the best for you and your family. I'm new here too and it seems like a great resource.

There's two things going on here at once.

First, your partner is jealous of your piano skills.  To me, that's silly because we all have unique skills and we get married to combine them to benefit the household as a whole.  You have a gift of music.  I have a gift with writing/marketing.  I'm sure your partner has gifts that neither of us have as well.

The jealousy part needs to be nipped in the bud directly because it quickly becomes toxic for everyone involved. 

The second problem is what your hesitation to teach your daughter piano says about you and your household.  You can't raise kids in an environment where they're only allowed to learn things from one parent if the other supports it as well.  I can see if we're talking about bow-hunting or skydiving since there's inherent danger and other moral issues involved.  But piano?  You don't need me to tell you that there's a serious problem with that.

But you're actually taking it a step further.  It's not even allowed to be talked about in fear of how your partner might react.  The kids will pick up on this in due time (if they haven't already) and it's giving them a very warped vision of how the world works. 

You- It's okay to ask some things, but never mention other stuff.
Kid- Why?
You- Well, we don't want to upset anyone.
Kid- Okay, but how do we know if what we ask will be upsetting? 
You- Well, we don't...so you'd better ask me things in secret before asking openly. 
Kid- Are you telling me to lie?  I don't understand...
You- Well, no, not really, but you should never say anything until I tell you it's okay. 
Kid- But why?  Why would she get mad at me for asking?
You- I don't know, but we need to be careful to make sure she's not upset.
Kid- So we just need to keep secrets from her?
You- Yes, exactly.  These are secrets just between us.  It's better for everyone.

That is so incredibly toxic and damaging for the kids sakes.  Hopefully you can see that and if any of these secrets came out in the open, I don't know that's something you'd ever come back from.  The feeling of betrayal would be off the charts bad.

The solution is to confront your partner directly.  Our daughter asked me to teach her to play the piano and since it's something I'm super passionate about, it's always been my dream to pass that along to our kids.  Of course you want that, who wouldn't?  So don't walk on eggshells, this is a topic worth putting your foot down on because it's a big part of who you are.

The resulting conversation might turn ugly, but you need to stand your ground and explain that this is about who you are as a person and the best interests of the kids.  This is not a reflection on your partner at all since they teach things to the kids all the time without stern protests from you.  Keep this about you, about the kids.  Use "me statements".  And prepare for some rocky days before this passes.

You have to though for the kids sakes.  They are worth fighting for no matter what.  And your talents should not be diminished just to placate someone else's bruised ego.

I agree with Pook's points, and I too would recoil from the notion that something is "unhealthy," "wrong" or "abnormal" with me or someone I loved.  These labels, along with "mental illness," carry a stigma.  Getting therapy once had a stigma too, though thankfully that is changing in my opinion.

While I generally agree that some BPD behaviors are self-sabotaging and damaging, they do nevertheless seem "normal" to me, in the sense that they are natural human reactions.  Anger, anxiety, fear, despair, hopelessness, jealousy, shame, disappointment, disassociation, numbness, etc. are feelings we can all relate to.  I just think that for pwBPD, these feelings tend to be disproportionate to the situation, as well as intensely felt.  It's like the frequency, intensity and duration of some negative feelings are super-sized with BPD.  That's where therapy can help, to reel the feelings in, get past them and learn strategies for coping better.  I think we could all benefit from learning coping skills!

I think BPD also involves a lot of black-and-white thinking, albeit overwhelmingly black.  One negative experience, and her mind fixates on the negative, blowing it out of proportion and seemingly selectively forgetting the positive when she's overwhelmed.  She lacks context, perspective, patience.  This tendency is directed both externally and internally, with self-hatred being a persistent problem.  She might fixate on one thing she doesn't like about herself, for example her facial structure or weight, and completely forget about her good qualities and talents.  Perhaps this is why her sense of self seems so tenuous.  My theory is that she ruminates on negative topics so persistently that she basically carves a rut in her brain, making her feel mentally "stuck."  Not only that, but she re-lives these negative thinking patterns over and over again.  Though rumination is a normal human behavior, she ruminates so much that it's interfering with her life and relationships.

I think it might be helpful to frame therapy, not as something to fix the person, but rather as getting support to help to deal with past traumas.  I think it matters less what the "trauma" actually is, because at the end of the day, your daughter FEELS like she's experienced trauma, she's having trauma-like, fight-or-flight reactions to everyday stimuli.  She just needs extra support to get past her past.  My pwBPD seemed to like that framing, as it validated her perspective that she was traumatized by life.  She also warmed to the notion of getting help from professionals, perhaps because of the lack of "emotional baggage" associated with doctors, as opposed to parents or family.  Besides, the doctors know what to do, they deal with these sorts of cases all the time.  She's not the only person in the world feeling traumatized and getting help to move forward.  There are proven protocols for dealing with BPD, such as DBT, crisis planning, medications targetting associated issues (e.g. anxiety or depression) and others.

Another approach that my pwBPD seemed to like was the notion that getting therapy was the mature and responsible thing to do.  What does a responsible adult do when she's not feeling well?  She goes to the doctor and does what the doctor recommends, because the doctor is a professional and has seen this sort of thing hundreds of times.  It shouldn't matter if the ailment is physical, mental or a combination.  Taking care of yourself is the adult thing to do, right?  It means you love yourself, and you'll do what it takes to feel better.  She really liked that idea, because her main issue was a preoccupation with feeling childish, inferior and "behind" peers her age, as she found the stresses of "adulting" overwhelming.  Perhaps ironically, getting therapeutic help was perhaps the most adult decision she made, as well as a first step towards taking responsibility for herself and her life.  After years of blaming others and avoiding responsibility, in typical BPD fashion, getting therapy was a reversal, because she was finally taking responsibility.  I really like framing it that way too.

Just my two cents.

Hi all, it’s been a while and thank you all as always for the support over the past five years. Married lesbian, dbpdw, four kids now aged 1-6.

So, I’m a pianist and piano teacher and bpdw continues to be jealous of my ability to play the piano, to use this for pleasure and work… She has always said she wants me to teach her but 12 years together and she’s barely managed any lessons because she has no patience and calls me the worst teacher ever and storms off. We don’t have time anyway with the kids being so demanding and bpdw finds learning and focusing on anything difficult.

A few years ago bpdw’s sister asked me if I could teach her little girl to play the piano (bpdw’s niece). Bpdw announced “there’s no way that’s happening I won’t allow it.” When sil asked why bpdw said, “because she’s my niece and I should be the one to teach her”. Sil pointed out, “but you can’t play the piano” and bpdw said, “I’m learning”. Needless to say the lesson never happened. Bpdw has expressed to me even before we had the kids that she would never allow me to teach our kids. I think she’s ashamed that she can’t play or teach them.

Years ago I remember expressing concerns on here about how I would handle it if the kids ever asked me for lessons. Well the other day I was online teaching and D6 came over and asked me quietly if I could teach her to play a tune. I said, “shhh not right now” and reminded her, “Mama’s working.” She has not mentioned it since.

My wife has been much more mentally stable since attending college and meeting new people recently. But I fear her reaction and how I should handle it if D6 was to ask about piano either in front of bpdw or when she’s not around. I don’t want to teach D6 to walk on eggshells. I’m pulled towards avoided the issue forever, to protect D6 from Mummy’s reaction. I also know that I have to be strong for D6. Her Mama is a piano teacher and she wants to learn to play, and as long as she wants to learn from me I want to teach her. Of course I haven’t mentioned it to bpdw. I really need some advice kind people.

I don't think this is something you should be directly involved with because it could come back at you if a public accusation is made and there's not enough evidence to prove it.

However, if you can't let it go, then report it to crimestoppers.  Those are anonymous reports and you can just say, "I saw a <color> <make> <model> with tag number <abc1234> swerving out of control and it knocked over a mailbox on <road>.  The driver appeared intoxicated and was standing up out of the sunroof when this incident happened.  I'm notifying you because there were kids in the car and I was frightened for their safety."

I wish you luck, my friend, this would drive me bananas as well.  Nobody messes with my kids...that's the one rule in life I'll never compromise.

As I shared earlier, for therapy to be effective, your daughter will have to want internal change and actually work through this to better herself.  That's a lot to ask of a teen though when the world says, "There's something unhealthy with the way you think and we're going to teach you how to overcome that." 

Who would accept a message like that?  Only someone that's truly fed up with the way their life is progressing.  For a teen, that's so hard to see.

Your job now is the same as it's ever been- teach right from wrong in a loving way.  That means treating your BPD kid differently at times and she's going to focus in on that and say that you're the problem for favoring her siblings.  You've learned from your first few books not to argue, but that's one narrative that you must always push back on.  You love her, you want what's best for her, and she must learn right from wrong.

When she misbehaves, punish her.  She'll rebel and try to punish everyone else.  It's incredibly hard and chaotic, but do not walk on eggshells and stand your ground.  Do not be manipulated into letting her get her way.  While it brings temporary peace to the home, it also enables her to lash out more the next time to get what she wants.  Everyone in the home will pay the price if you walk on eggshells.

One last thing; my daughters are 25 and 27, with the older one being BPD/Bipolar.  The younger was bullied, made fun of, and hated because she was viewed as the favorite.  It was never that; the younger listened to mom and dad while the older one didn't.  It was incredibly hard at times but my kids are still close today and have a good relationship.  That aspect will work itself out in time as your kids get older; don't sweat it too much!

Hi again,

That sums up pretty well some of the issues the pwBPD in my life faced in early adulthood.  I find it a bit perplexing though.

On the one hand, there's the fear of abandonment.  I think that for my pwBPD (adult stepdaughter), it isn't so much abandonment that's the issue, but rather dealing with feelings of "rejection" . . . like she doesn't measure up and can't have the friendships or lifestyle she craves.  This issue emerged mostly vis-a-vis her peers, particularly other women (think, sorority sisters and roommates).  My theory is that my pwBPD has unrealistic expectations about the amount of "devotion" she demands from her friends.  I think she expects for relationships to be too intense, and when her friends don't measure up, she feels "rejected."  I can only imagine how all these feelings are supersized in the age of texting 24/7 and performative posting on social media.  Any post by a friend without her, and she could interpret it as being purposely excluded.  She takes everything uber-personally, not just as an insult, but as a personal affont.  I think she feels "unloveable."

I have a sub-theory that my pwBPD expects to have such intense female friendships because she never really bonded with her mom, and she's looking for a substitute mom?  Yet if she demands motherly attention and nurturing from her female friends all the time, well, then she's constantly disappointed.  I get the sense that she sees friendships in all-or-nothing terms.  But I think for most people, friendship intensity varies from superficial to close, depending on the situation--a classmate, workmate, gym buddy, roommate, teammate, neighbor, childhood friend, etc.  Even the best of friends won't act like a substitute mom, doing the emotional caretaking and reassuring that the pwBPD seem to demand.

Then there's the anger.  Indeed it seems to come out of nowhere, at first.  She'll typically react with anger when she feels slighted by others.  But as I've witnessed her outbursts over the years, I think I've identified a pattern.  I think her outbursts have very little to do with what other people did.  I think she was just letting out her supreme frustration and ire to DEFLECT from her fundamental issues of feeling lost and inferior.  It's all a distraction!  Look, her typical reaction to life's stressors, pressures and disappointments was to hide away in her room.  That is avoidance, the "flight" response.  But then she'd encounter some sort of extrenal trigger--usually a disappointment in her life--and she'd unleash her anger onto someone else, for a completely unrelated "offense."  If there wasn't something to latch onto and be offended by that day, she'd dredge up a grievance from a decade ago.  Her brain would invariably concoct a victim narrative, how somebody aggrieved her and traumatized her, and she'd let out her anger.  Yet, most of the time she was projecting her inner ill feelings that were welling up because of something completely unrelated.  You see, she was angry at herself.  For giving up.  For wrecking her friendships.  For not taking care of herself, living like a slob, sitting on the sidelines of her life, not going anywhere, feeling stuck, hating everybody and everything, most of all herself.  Add to that an extremely negative self-image (hating her body, face, etc.) and striving for impossible beauty standards, and she doesn't want to live anymore.  She can't get away from herself and all her negativity!

Since those feelings are too intense though, she turns them around and blames YOU for ruining her life.  You're mean, narcissistic, controlling, lazy, manipulative, a liar, abusive, and worthless, and you'd be better off euthanized.  Moreover, she didn't ask to be born, it's your fault she's miserable, you OWE her.  If you don't give her what she wants, she might as well just die.  That right there is what I call going "nuclear."  She's threatening her life to get what she wants.  She's initiated a nuclear threat of mutually assured destruction.  In my opinion, once she crosses that line, she is bound to escalate unless she gets some therapy.

While of course it is not this, but maybe it can be likened to an emotional version of Tourette Syndrome with its uncontrolled outbursts.  DBT works on fostering mindfulness (or wise mind) to train the person to be more aware and learn how to examine and process their feelings in a more healthy way.

I don't have anything helpful to say, but this is utterly horrifying and traumatic. I am so sorry your daughter has to live in that environment where life is treated as disposable like this

My goodness, I am so grateful for all the responses and the support. This community seems like exactly what I (and my daughter by proxy) have needed. It's been difficult finding anyone other than medical professionals and my sweet mother who has walked this path with us, that understand even a little bit of what our days are like.

Since posting, my daughter's psychiatrist has diagnosed her with PTSD and Emerging Borderline Personality Disorder. She agrees that she meets all the symptoms and is treating her as though she is diagnosed with BPD, while waiting until she is 18 to put that final diagnosis in her chart. Although the treatments have not changed and we are on the same course we were, I do think it helped my daughter to finally feel like someone listened to her. She had been telling every physician we see that she thought this was her diagnosis only to be blown off.

She has been in therapy for over a year, but since leaving residential, I do feel as though she is taking it more seriously. She does 9 hours of DBT group therapy a week, 1 private therapy session and we have always done family therapy. There are some days where she absolutely refuses to join session and locks away in her room. That seems to be a common theme for when she is dysregulated. She will lock herself in her room and sit behind her door so no one can come in. I have tried to encourage her when she is in moments like this and remind her of all the things her therapist has suggested (you are loved, we are here for you, this is just a moment and not forever, etc.) but it only seems to make it worse and she gets more emotional and angrier. I have learned the best thing I can do is leave her be and check on her every so often.

Anger is the hardest part for me. She can be so happy and enjoying time with myself and her sisters and then out of nowhere, she is cussing us out, calling us horrible stuff, throwing things, punching walls, etc. We do live on eggshells with her and the whole house tries our best not to "trigger" her. It's been difficult for my other daughters because their big sister is a completely different person. I know one person responded to me saying this happened overnight and maybe there were signs we missed, but even my daughter explains this the same way. Her psychiatrist told us it's not uncommon for this to pop up like this one day and she has experienced this same thing happening with teenagers around her age. Her body and brain just when into "fight or flight" from all the trauma one day.

There were some books suggestions, and I have read "Walking on Eggshells". I just got "I Hate You, Don't Leave Me". These have been very helpful! Send all the resources, I’m here for them!

It seems to be her core symptom is abandonment. She and her sisters were abandoned by my now ex-husband and their father seemingly overnight. I could go on all day about all the things he did to hurt them in this time of our lives, but it doesn’t even matter. This left my daughter with a deep seeded fear of being left again. We had a saying when they were young ... anytime I had to go somewhere and leave them with my mother, or other caregiver, we would repeat ... "Where is mom going, NO WHERE". It was always my oldest daughter (the one referenced here) that had the biggest fear of someone leaving her again. She always needed a lot of reassurance that I would be back. It was heartbreaking to watch. It still is. Where she doesn't think I am going to abandon her anymore, it has turned to "just leave me, get rid of me" in moments of dysregulation now.

My heart goes out to everyone who has someone in their life struggling through this. I have spent countless hours crying over watching my child feel a pain that I cannot take away for her. And it's so hard to explain to someone that when she is cussing me out and treating me horribly, that this is pain for her. They see it as a "bad child that needs discipline" not understanding that she doesn't want to feel like this or act this way. After a splitting episode, she is always remorseful and cries, begging me to help make it stop and she just wants her life back"

I so appreciate all of you and want so much to be the same support one day for others going through this, as you have all been for me in this post. I have learned over the last year that finding "your people", those whom you can vent to, and they understand is a very important form self-care. So, thank you so much for showing up for a mom when she needed it most. I am utterly grateful for all of you and look forward to a continued journey with any and all of you!