Sis diagnosed with BPD but adamantly refuses to seek help

[AuntPam]

For the past three decades, we've gone through the same cycle.  She's mad at me, or my (normal) sister, or my mother, or my father.  For the past two decades, she had a child to play helicopter parent to--and now he's gone to college and has experimented with marijuana.  She has turned this into the drama of the century and has whipped herself into a frenzy.  When we refused to agree that he's in immediate danger--he's actually a nice kid, trying to grow up and start an adult life--she called all of us vicious names and made ridiculous allegations (recently she's started saying that I am having a love affair with her long-divorced husband (!), who I've probably seen a total of 8 hours in the past 14 years, every one of them in the company of my husband.)

I've read the research and I understand she has a brain that is physically wired differently than normal.  But the hatred and psychotic vitriol I've had to listen to is just completely over the top.  I am thinking of telling her that it's NC from now on unless she seeks and stays in treatment.  I think my other sister will support me.  We worry that she will try to kill herself if we tell her this.  But I can't have the peace and harmony of my household shattered every six months or so when she goes through one of these rage fests. 

There's no point in reasoning with her.  I actually want to make her weigh the possibility of total abandonment against the "humiliation" of FINALLY seeking help.

Any chance this will work?

[Turkish]

Hello AuntPam,



It's good that you've done research on BPD to understand the physiological factors which contribute to the disorder. Have you come across the material on the communication tools to help reduce conflict? We have a wealth of information here.

While NC is sometimes a necessary tool used by members to protect themselves from severe cases of emotional or physical abuse, going cold NC, can often trigger extreme reactions. pwBPD (people with BPD) intensely fear abandonment, despite the fact that their behaviors often result in driving people away.

Have you read up on validation? After first developing DBT, Marsha Linehan, herself a BPD survivor, incorporated it into DBT, and it yielded more positive results with her patients.

Communication using validation. What it is; how to do it

Do you think this might help?

Can you describe the rage fests? Are they severe enough that you and your family don't feel safe?

Turkish

[Kwamina]

Hi AuntPam

I would like to join Turkish in welcoming you to our online community

He has giving you some great advice about the communications tools. Communicating with someone with BPD can be quite difficult and frustrating so I understand where you are coming from. Something that helps me is keeping the following in mind:

Telling a person she shouldn't feel the way she does feel is akin to telling water it shouldn't be wet, grass it shouldn't be green, or rocks they shouldn't be hard. Each person's feelings are real. Whether we like or understand someone's feelings, they are still real. Rejecting feelings is rejecting reality; it is to fight nature and may be called a crime against nature... .Considering that trying to fight feelings, rather than accept them, is trying to fight all of nature, you can see why it is so frustrating, draining and futile.

Being subjected to verbal abuse isn't pleasant at all. Setting and enforcing/defending firm boundaries is very important when dealing with a BPD family-member, to help keep yourself safe and preserve your own well-being. In addition to the link Turkish has shared with you, I also suggest you take a look at our resources about boundaries and ways to assert yourself:

Setting Boundaries and Setting Limits

BOUNDARIES: Examples of boundaries

Assert yourself: D.E.A.R.M.A.N. technique

The D.E.A.R.M.A.N. technique is helpful for asserting yourself. The acronym stands for Describe, Express, Assert, Reinforce, Stay Mindful, Appear Confident and Negotiate:

D.E.A.R.M.A.N. is used when you have an objective, you want something specific, such as to get more sleep, to have help with the chores, to affect a change or to say NO to a request. You want the other person to come away feeling good about you and not full of resentment. This preserves the relationship. You also want to protect or even enhance your self respect

... .

DEARMAN is not simple to do: Steering a conversation through 7(!) defined steps with a person that is prone to dysregulation while you are feeling possibly weak and insecure is virtually impossible.

The key to acquire the skill for DEARMAN lies NOT in following the letters. It lies in learning the underlying skills and practicing them well enough to then being able to steer a conversation through DEARMAN. When looking at DEARMAN it is clear that we are to express needs for change.

... .

DEARMAN is valuable skill that at its very core boils down to:

We have a right to ask for change - the other side may or may not agree, that is fine too.

When owning up to our requests, staying respectful and focused on what we want we improve our chances for affecting change.

Has your sister ever been diagnosed with any kind of mental, emotional and/or behavioral disorder? Has she perhaps ever gotten treatment/therapy for her issues?

[AuntPam]

My sister had some terrible experiences when she was about 16-18 years old, involving an obsessed boyfriend, an unplanned pregnancy, and the screwed-up mores of the time.  She had to give up her baby.

We never talked about it.  The advice at the time was "don't open old wounds."  I can see now that was a mistake.  And we're truly sorry about her suffering and wish we'd understood this all better.

However, from her teen years on, she exhibited behavior where she would get into rages about trivial stuff.  Here's a story: when she was in her early 20s, on a date with a guy, her jacket was accidentally left in the back of a taxicab.  She came to my apartment, raving about how it was all his fault, that he should have spotted it.  (This is years before I ever heard of BPD.)  I tried to reason with her (stop laughing) but she went away mad.  The next day she reappeared to tell me that she had gone to the antiques store where he worked and insisted that he had to pay her for the lost jacket.  When he refused, she told me that she picked up a fork and left five deep scratches in the top of an antique dresser.  I told her this was crazy and she became enraged at me, so I told her to leave.  She didn't speak to me for about six months.

Visiting my mother on one occasion, she got into a fight over something my mother didn't agree with here on (probably an extreme, provocative, political view.)  She decided that she would "take back" the many pictures she'd given my mother over the years and raged through the house pulling them off the walls.  My mother was so frightened that she called the police to get my sister to leave.

I could cite numerous other examples of this stuff, in which a relatively minor disagreement over trivia suddenly escalated into shouting and abusive language (she says amazingly ugly things when she's out of control.)

The family has, over the years, become expert at subject changes, distracting behavior, refusing to rise to the bait of fighting back no matter how nasty she is.  But this also means that, for instance, I never tell my sister anything important about my life:  she will use it in the most hurtful way she can the next time she goes gonzo.  She does not understand the idea of playing fair.

And yes, it's truly frightening.  Last Friday, I called the police to get her to leave my house:  she came by to drop some stuff off for her son (who's currently refusing to speak to her) and suddenly demanded that we get some of her belongings that have been stored here for three years immediately out of the attic.  She knew I was in the middle of a busy work day (I work from home) and began shouting and yelling when I said that it wasn't a good day to do this.  As soon as I called the cops, she went out to the porch and sat there, alternately cursing me and pounding on the door for ten minutes.  Thank God she was gone before the police arrived.  But we've kept the doors locked since then (and made arrangements to return her belongings.)

She's made at least one suicide attempt... .she slowly destroys her relationships with everyone because of the behavior.  And if you even bring up the idea of seeking help, she immediately escalates into rage "You're trying to tell me I'm crazy! You're trying to MAKE ME crazy!"

I get the point about validating her feelings, but she won't accept anything less than full surrender on an issue where we disagree.  I can't just say "I can see how you feel that way."  If I don't 100% agree with her that [latest villain] is The Worst Person In The World, that "proves" that a) I don't love her and b) I am on [villain's] side.

That's what I can't get past.  When she's calm, any discussion of changing things rapidly leads her to be nuts.

Help.

[Kwamina]

Hi again AuntPam,

Your sister's behavior unfortunately does sound rather disturbing indeed. She made a suicide attempt which I can imagine must also have been very hard for you and the rest of the family.

It really is a very sad and difficult aspect of BPD that some people with this disorder have suicidal tendencies. Did anything in particular lead up to her suicide attempt? What happened afterwards, did your sister perhaps get some targeted help for her suicidal ideation?

It says a lot that you were so concerned about her behavior that you called the cops.

Validation is just one of the techniques described here and it can be very helpful in certain situations. There are also other techniques though and depending on the situation one may work better than the other.

When it comes to keeping yourself safe, I'd say setting and enforcing/defending firm boundaries is definitely advisable. This of course doesn't mean that she'll respond positively to them. However, the most important thing about boundaries is that they are about you and protecting yourself, regardless of whether the other person changes or not.

[AuntPam]

At the time of her suicide attempt, she had broken up with a boyfriend and was having some work difficulties.  She began having what I would call paranoid fantasies (some friends were "out to get her" and exhibiting physical symptoms that didn't add up.  Claimed that she had incredible back pain, but doctors could not find any physical cause.  Lifted heavy objects, moved normally, full torso flexibility.  I was staying with her for a few weeks because I was so worried.  Then I came down with a horrible 24-hour gastric flu (a number of my friends got it too, not psychosomatic) and was so sick that I went home to avoid infecting her.  I tried to stay in touch by phone, but a few days later she stopped answering calls.  Had her landlady check on her and she'd taken all her pills, made a couple slashes at her wrists, and turned on the gas. 

So she wound up in a local hospital.  Where the staff seemed to think that it was all the fault of our family. 

I worry that she will try something like this again.  She seems to be spiralling into a really bad time.  Yet speaking to her is impossible.  She really hates me right now.  And she continues to insist that there's nothing wrong with her, but that her only child now away at college is "IN DANGER!"  I'm quoting, including the capitals.

Sorry these messages get bogged down in the details of crazy, but they help you understand where things stand.  Likely she will be cooled down in about six to eight months.  Assuming she doesn't do anything harmful to herself.

My other sister, who is a big help at times like this, unfortunately lives halfway across the continent.  And has a pressure job dealing with hospice patients and their families. 

I tried writing a letter to my sister using the DEARMAN outline.  (Not sending it.  Not yet anyway.) And we had been getting somewhere recently with the SET style of communication.  Meaning I'm willing to acknowledge how she feels and empathize with the pain.  It's the T part that's hard, because when you ask her to think about factual matters, to examine an objective Truth, she views that as an attack on her.  Or if you dare to disagree with some nutty conclusion (for example, she's obsessed with some kid who was a friend of her son about ten years ago: his "bad influence" is the reason why her son is now acting the way he is), it means that you are "not listening" to her.  Not true.  I listen to her.  I just don't agree that a a kid friendship is responsible for every disobedient-child thing her son has ever done.  And he's 20 now.  She can't hope to control him, especially when her only tool is to get into screaming rages with him if he stays out late.  That's really not effective with people old enough to leave home, stay with friends, work legally, cross state lines.

I have realized that lately, as much as I want to love my sister--who can, on rare occasions, be kind and loving--the two main emotions I feel about her lately are fear and anger.  I'm afraid of what she will do next.  I'm furious that she has been abusing us for decades and not only won't stop but will never admit or apologize for what she has done. 

Yes, she has a personality disorder.  But she makes the choice, over and over, not to see the havoc it wreaks and not to get treated.

By the way, the stuff at this website is actually really helpful.  And the answers to these posts make me feel a lot better too.  I had no idea how many people are out there trying to cope with this s**t.