SO's D19 bipolar dx and whether to meddle

[livednlearned]

I am torn about what to do.

SO's D19 is diagnosed bipolar with psychotic depression (dx'd at 16). She lived with us for the summer and I suspect BPD.

Fear of abandonment, identity confusion, unstable relationships, emotional dysregulation, distorted cognition, needy/clinging, binge eating, psychosis, anxiety/depression, perfectionist.

A few weeks ago she gave her psychiatrist permission to tell SO that D19 was having chronic suicidal thoughts. She has a plan  

After the call, SO drove up there (D19 is at college) and then last week, D19 drove down here before school starts.

When D19 lived with us last summer, SO and I ended up in couples counseling to help deal with her, and the T mentioned to me in individual therapy that she thought D19 sounds BPD. I had wondered if it was maybe dependent personality disorder and T explained she could be both.

I have not told SO about that conversation. He notices that I have a way with D19 (thanks to skills I learned here ) and this last flare-up with D19's suicidality made me wonder if I am doing the wrong thing by not saying anything.

D19 is more of a depressive internalizing BPD subtype (quiet borderline) and she has two therapists and a psychiatrist. I have this feeling she would embrace DBT or other BPD therapy and find some relief. Right now, she is feeling like the medications aren't helping and I keep thinking she is looking for answers, and she won't find them with medication alone.

What to do? On one hand, it feels like it's not my place and I should butt out. On the other hand I feel like this young woman (child, really) is suffering so much. I know some people with BPD can go decades before they get the right diagnosis.

Do I keep quiet? Say something? Call her therapist confidentially for a 10 min conversation with my thoughts?

I talked to my T about it, and she said it's a draw in her mind. I felt at peace with not saying anything until the call from the psychiatrist came about D19's chronic suicidal thoughts.

I feel she deserves to learn how to live a life worth living, and that there are therapies beyond meds to help her with that. I think she is the kind of person who might actually welcome the diagnosis, like the woman who wrote Buddha and the Borderline.

Anyone have any thoughts about what I should do? If I were to meddle, my inclination is to call D19's T here in town (they do phone coaching, and D19 sees her when she visits us) and let her take it from there.

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

[Fie]

Hello Livednlearned  

Have there been situations in the past where you thought you went too far by interfering ?

I am asking because to me this does not seem like a situation where you should keep the information you have for yourself. How about informing your SO ? Since he's the father maybe it's in the first place up to him to decide to inform his D's T? If he decides not to, you can still think about doing it yourself ?

If I were you, I would certainly not keep quiet. You will do everyone a favor (in the longer run at least) by sharing the info, also yourself.

Let us know what you have decided, if you want !
Fie

[Lollypop]

Hi there LNL

I hope you don't mind me sharing my thoughts.  I can see how difficult it must be for you and you obviously care about your DD.

I'd try to keep to the facts.

she has two therapists and a psychiatrist.

A few weeks ago she gave her psychiatrist permission to tell SO that D19 was having chronic suicidal thoughts. She has a plan.

She's experiencing a difficult time at the moment and wanted her dad to know. I see this as a very positive step and she appears to have a psychiatrist that she trusts.

If she isn't responding well to her meds then I wonder when the psychiatrist will review her situation and at what point another diagnosis is at least considered.

Given that your husband has spoken with the psychiatrist it would seem to me the best place to start to raise some questions about her treatment, meds and diagnosis.

I can see it's a tricky one. My own BPDs is a quiet borderline so I understand how worrying internalising can be, particularly as they can mask so much. Personally speaking, my BPDs was very relieved to have a diagnosis and he got an answer. He's found it difficult as he's refused to seek treatment and the reassurance that professionals can bring so he's a very negative view on his prognosis.

Has there been any recent changes in her meds?
How's college going for her and does she want to continue?

Hugs

L

[livednlearned]

Have there been situations in the past where you thought you went too far by interfering ?

That's a good question. I think no? I feel the severity of the situation much more than D19's dad -- he normalizes it, and is prone to fixing instead of coaching. I'm very diplomatic (I had a step son in a prior marriage and learned some things  ) and more likely to coach SO than directly meddle. That said, I do coach a lot   

How about informing your SO ?

I tried once. SO's sister is uBPD, his mom seems to have traits, and SO's ex-wife is uBPD. He also works in a hospital and deals with high-conflict people who tend to have a PD of one kind or another. I once asked him if he ever wondered if D19 might have BPD -- he had just finished saying that he wasn't sure D19 was bipolar. When I raised the topic the doors of denial shut hard and he changed the subject so fast I could see it was too stressful to contemplate. I also don't think he understands how BPD can present in different ways. D19 internalizes whereas the rest of the people in his life with BPD all externalize with outbursts.

Since he's the father maybe it's in the first place up to him to decide to inform his D's T? If he decides not to, you can still think about doing it yourself ?

I'm trying to imagine what a therapist would think if her client's father's girlfriend called to suggest BPD   It just feels like crossing a boundary, tho my family of origin was so secretive and closed that I'm not sure whether that's influencing how I think about this.

If I were you, I would certainly not keep quiet. You will do everyone a favor (in the longer run at least) by sharing the info, also yourself.

By telling SO what I suspect? Or do you mean by telling D19's therapist?

When D19's psychiatrist called about the chronic suicidal ideation, SO said he was going to insist D19 get a new psychiatrist who was local (D19 has been sticking with the one where we live, 5 hours away), and same for a therapist.

I could also wait to see if the new psychiatrist recognizes she has BPD symptoms, though I suspect it is much harder to tell with patients who internalize.

[livednlearned]

She's experiencing a difficult time at the moment and wanted her dad to know. I see this as a very positive step and she appears to have a psychiatrist that she trusts.

Me too. Her compliance with psychiatrist/therapy is what makes me hopeful that a BPD diagnosis would actually bring her some relief. She is not stigmatized by being dx'd bipolar -- she disclosed it to me early in our relationship and has also talked about her anxiety with me.

If she isn't responding well to her meds then I wonder when the psychiatrist will review her situation and at what point another diagnosis is at least considered.

I think the psychiatrist here weighs her and chats for a while, then makes minor adjustments. I don't get the impression that D19 is describing the more persistent personality challenges she experiences.

Given that your husband has spoken with the psychiatrist it would seem to me the best place to start to raise some questions about her treatment, meds and diagnosis.

He is a really smart guy with all the information right in front of him. The fact he is not putting two and two together makes me think his denial is pretty deep. He does not want his D19 to have BPD -- that's what his ex wife has  so I'm sure there is some fear there for him.

I understand how worrying internalising can be, particularly as they can mask so much.

Oh my gosh does she ever mask a lot. I can see so much going on under the surface. I think, tho, that SO interprets her disassociation and masked expressions as though she is doing ok. My T describes SO as being "allergic to strong emotions" which means he interprets D19's internalization as a sign she is doing ok.    He seemed surprised that she was experiencing chronic suicidal ideation and keeps trying to figure out what event triggered it, whereas I see it as a part of something much more pervasive to her sense of self.

Personally speaking, my BPDs was very relieved to have a diagnosis and he got an answer. He's found it difficult as he's refused to seek treatment and the reassurance that professionals can bring so he's a very negative view on his prognosis.

That must be so hard, to have him feel relief and then see him reject the help he could get.

Has there been any recent changes in her meds?
How's college going for her and does she want to continue?

I believe they just changed her meds after this recent go-around.

As for college, she is doing well academically (she's very bright and her perfectionism leads to her doing assignments in advance of deadlines). She wants to continue, but socially her relationships are very unstable and she is on her 5th living arrangement in less than two years, which isn't that strange for college students. Except that she is also BFFs with someone she recently met and then they become "devil Satan roommates" that she never talks to again.

Where I'm at right now is this: I can at the very least leave a voice mail message with D19's current T (who is here in our town) and tell her that I have BPD in my own family and feel certain I see it in D19.

And then let it go.

And hope.

[Lollypop]

Hi lnl

He is a really smart guy with all the information right in front of him. The fact he is not putting two and two together makes me think his denial is pretty deep. He does not want his D19 to have BPD -- that's what his ex wife has sad so I'm sure there is some fear there for him

I think my husband would be exactly the same. He finds the whole parenting BPD thing just exhausting and to be honest finds it difficult to cope but he's picked up some skills alonf the way.

It's very tricky for you if your husband can't have the conversation yet. Of course his own experiences must have been traumatic for him too.

Good luck and let us know how you get on

Hugs

L

[Fie]

If I were you, I would certainly not keep quiet. You will do everyone a favor (in the longer run at least) by sharing the info, also yourself.

By telling SO what I suspect? Or do you mean by telling D19's therapist?

I meant by telling your SO. But I understand what you are saying about him being more or less in denial.
I get the impression that you'd feel better if you got it off your chest. I think I would feel the same. So in this case I think talking to the therapist might be a good option. In your situation I think I would do that. I would wonder if I would be crossing a line by doing it. But on the other hand, I would also wonder if I would be crossing a line by *not* saying anything. Either way there is no perfect solution. You have to choose the better option between two not so perfect options.

So I think you have to do the thing you feel best with. I get the impression that you would feel better if you did something, is that correct ?

Me personally I think I would inform my SO if I would talk to the therapist. I'm aware things could get a bit awkward after that, but in the end honesty lasts longest and at least you will have a clear conscience about everything you did.

[Grey Kitty]

First, I'm confused about how many therapists, psychiatrists, and other mental health professionals are involved in treating SD19, and if they are talking to each other.

I don't think they can talk to you about her without a release, but they can listen to you without talking about SD19 to you.

It seems reasonable for you to call any and all of them to inform them that you have personal history with BPD, and that you suspect SD19 has it and so does her mom... .at least if this is new information to them. What they do with the information is up to them.

He is a really smart guy with all the information right in front of him. The fact he is not putting two and two together makes me think his denial is pretty deep. He does not want his D19 to have BPD -- that's what his ex wife has  so I'm sure there is some fear there for him.

As for SO, you can coach him on the tools, without ever mentioning BPD, and I'm pretty sure you have done plenty of that, and will continue.

When somebody close to you appears to be in denial like that, keep quiet if you aren't sure what to do. That said, there are times to give him just the kick he needs, and it might make a difference. Those times are very rare, but they do come up now and again.

[livednlearned]

Thanks GK.

There is a psychiatrist here in our town that D19 has seen since age 16 when she had a psychotic break. She was dx'd bipolar with psychotic depression by that T. SO (and I) have never seen mania in D19, so the bipolar dx is a bit of a mystery.

D19 also saw a CBT therapist here in our town, who continues to do phone coaching. When D19 stays with us, she goes to see that same T.

There is apparently a new therapist involved up in D19's town, as a result of the suicidal ideation.

The therapist I would communicate with is the one here in our town. I don't expect her to say anything to me about D19 and would be worried if she did! Though I do expect it would be helpful to share some behaviors that I see.

Talking to you all has made me see two reasonable options:

1. Encourage SO to talk to the therapist here, and if he wants, I can accompany him.
2. Call the T and have a quick call with her, keeping full confidence and not discussing with SO.

Option 1, I would be less likely to suggest BPD. More along the lines of: point out the behaviors, and raise the issue of D19's mom being BPD.

Option 2, I would be more direct about BPD. And run the risk of stepping in a big pile of none-of-my-business if the discussion ever got out. Although I know SO would understand it was coming from a place of concern for D19... .

The place where I catch myself is thinking how I would feel if the shoe were on the other foot.

It's probably better/healthier for my relationship is to do option 1.
It's probably more helpful for D19 to do option 2.

[Grey Kitty]

I've got nothing new to say about what benefits SD19... .but thoughts about SO and the potential fallout if you take option #2.

If you decide to attempt to push through your SO's denial about SD19's BPD/BPD traits beforehand... .or at least before he realizes you talked to T about it, then you are in the clear because you aren't telling the T anything you haven't already told SO.

Giving your SO a push like that is also a bit of a relationship risk, but a positive outcome would have relationship benefits, at least. (No idea how to evaluate the chances for you tho)