Mother looking for advice ...

[ButterflyBaby]

I've never really posted in a forum before, so excuse if my thoughts are a bit scattered.

My daughter began showing BPD traits over a year ago. She is currently 15. In the beginning, every medical professional we met with diagnosed her with bipolar disorder. She began therapy and medications immediately. After a year of changing therapy, changing medications (many times) and a PHP program, I had to make the choice and send her to a residential treatment facility. She spent 60 days there. During that time the on call psychiatrist agreed that she was misdiagnosed and was not bipolar, but had BPD. She would not formally diagnosis her because of her age. Fast forward to today and she is currently doing and IOP program and I have been told the same thing, "We agree she has BPD but we won't label her at this age". Unfortunatly the IOP is not working and it looks as though she will need to go back into residential treatment.

My question is, are there any parents whose children have been given this diagnosis during the teen years (or younger) and did it make any difference in the treatment they received? Nothing seems to be helping her and I don't know if medical personal would take a different approach if she were properly diagnosed.

I just feel like my child is a completely different person these days.  And it happened what seems like overnight.

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

[Pook075]

Hello and welcome to the family.  I'm so sorry you're going through this and I'm going to try to be brief here.  I went through the exact same thing with my daughter, who's now 27.  She was first diagnosed bipolar and it switched to BPD. 

A criteria of being diagnosed BPD/NPD is that you're 18 years old.  Why?  Because sometimes, kids can grow out of it and doctor's don't want a life-long diagnosis if it's not necessary.  Once it's on your chart, it's almost impossible to remove.  So doctors and psychiatrists are very careful what they actually place into writing for minors.  Bipolar doesn't have that same criteria though, so it can be diagnosed at any age.

For what it's worth, my kid is diagnosed BPD/Bipolar/ADD.  I don't know if I agree but in the grand scheme of things, it actually doesn't matter.  Here's why.

You mentoned that the treatment hasn't worked, which means you're looking at this like the flu or a broken arm.  For that stuff, there's logical steps to get the patient better.  Take the meds, get some rest, eat a balanced diet and waalaa...the patient is cured.

For mental illness, it takes complete buy-in from the patient to actively change.  You have a rebellous teen who's mentally ill, who likely resents you and resents her care team even more.  Of course she's not getting better, she's not trying to get better because she sees "the problem" as all the people who's telling her what to do.  Until she actually realizes that the problem is inside her, the best therapists in the world aren't going to make a bit of difference.

My kid was particularly stubborn and it took a series of terrible choices for her to finally realize that she needed to change.  That happened when she was 23 and both her partner and her best friend cut her off.  They were right in doing so, my kid did them both wrong and got caught doing it.  But it was devestating and she was suicidal for weeks.

This might sound horrible, but betraying the friends and having her heart ripped out was the best thing that ever happened to her in life.  That was the thing that actually made her realize, "Hey, I destroyed both these relationships because of what I said and how I acted."  She had nobody to blame but herself, and it was the first time she actually started working in therapy.  Within 12 months, she was a different person entirely.

My kid is still mentally ill and she still has bad days.  She has learned to manage it though and let go of those deep, dark thoughts that send her spiraling.  She also understands relationships a lot better now and how to treat people; especially those she's close to that do a lot for her.

I've lied, I didn't keep this short after all.  But I wanted to give you the full picture of the path your kid is on.  Medicine can help somewhat and therapy let's her get out some emotions.  Those are surface-level fixes to a much deeper issue though.  It's like taking Tylenol for a broken arm- maybe it helps with the pain for an hour or two, but the problem remains.  More Tylenol doesn't fix anything.  Dealing with the root problem does.

One last thing.  As a parent, you'll try working harder than your child to "fix her."  You'll think, "If I just tell her enough times, she'll get the picture and this will all work out."  But that's only pushing her further away because she feels like you don't understand her and are rejecting her.  There's so much more we can talk about, but know as an intro that this is not your fault, you can't fix this, and you're going to learn quite a bit about affirmation and boundaries while you're here.

Please ask the tough questions or let us know where we can specifically help.  Again, my heart breaks for you!

[Notwendy]

Did a diagnosis of BPD make any difference in the treatment they received? Nothing seems to be helping her and I don't know if medical personal would take a different approach if she were properly diagnosed.

I just feel like my child is a completely different person these days.  And it happened what seems like overnight.

I think a main question is- if they officially diagnosed BPD- would it lead to specific treatment that could be more effective?

Note- we are all lay people here with our own experiences, so these are not professional opionions. I think you know that but I wanted to make this disclaimer.

There isn't a specific medicine for BPD. Medicine can be used to help some associated symptoms. In the case of my BPD mother, she took medicine for anxiety- and so "anxiety" was the diagnosis on her chart. Her medical team was aware of her BPD, but as a diagnosis, it would not have changed the choice of medicine to treat her because there isn't a BPD medicine.

There are certain therapies that have helped pwBPD and other disorders. DBT is one of them. If there is a history of trauma, then EMDR helps with that. However, in a 15 year old, how much of her cognitive and emotional development at 15 to work with these therapies is a part of the decision. If there's a history of trauma, she may be too young for EMDR. So the benefit of having BPD on her chart may be lessened if she's too young for full participation in these therapies.

They may also feel she's too young for this diagnosis to be official on the chart, since she's still maturing. The therapists can be aware of it, without it being on her chart yet. Since she's young, they may be incorporating therapies into age appropriate approaches with her.

With a sudden change in her behavior, I assume they have looked for and ruled out other causes, medical, events that cause emotional trauma, bullying, abuse, and substances. This isn't to blame parents- even with good parenting and monitoring, kids today can be exposed to the internet, cyberbullying, through peers. Sometimes none of these are factors, but I assume they've looked at these to rule them out.

Since she is a minor, I also assume her treatment plan includes family therapy and meeting with you as parents. If BPD is being considered, you can go ahead and learn about it without having a definite diagnosis at this time. It can help to have your own personal therapist for support as you navigate this situation.
 

[CC43]

I just feel like my child is a completely different person these days.  And it happened what seems like overnight.

Hi Butterfly,

You've come to the right place.  Many people come here looking for answers and advice, while others seek an outlet for their thoughts and feelings, because living with BPD can be challenging.

When I found out the diagnosis for the pwBPD in my life, I searched the internet to learn more, because I had never heard of BPD.  The first thing I read is that it's treatable.  That was a huge relief to me.  A challenge though is that there's no magic pill, though medications can help with anxiety, depression or other co-existing conditions, which seem to be common.  Medications might help stabilize your daughter, but they don't deal with the underlying issues of overwhelmig emotions, negative thinking, volatile relationships and unstable sense of self.  That's where therapy can really help, provided that your daughter does the work of therapy.  Therein lies the rub:  therapy won't help much unless your daughter actually does the work.

I highlighted an interesting comment from you, which is the observation that the changes in your daughter seemed to happen overnight.  While that could happen, especially if there were a traumatic event or major disappointment in her life (e.g. a first break-up), my sense is that many parents here have observed that their kids have always been wired to be extra-sensitive and potentially "difficult."  Nevertheless, I think that sometimes it's hard to differentiate between what constitutes "normal" teenage behaviors from BPD.  After all, most teens experience super-sized emotions and changing feelings about their identity at some point--I think that sort of thing is part of growing up.  It's perhaps for that reason many doctors won't diagnose BPD until adulthood.  Having said that, I personally wouldn't consider recurrent cutting or suicide attempts as "normal" teenage behavior.  My guess is that your daughter has been a danger to herself or others, in order to land in a residential treatment facility.  That's how the pwBPD in my life ended up, multiple times.  Fortunately for her, she decided to take therapy seriously, and she turned her life around pretty quickly.  Though she still struggles, particularly with interpersonal relationships, her life looks much, much better today than it once did.

Though I imagine you've been through so much and have probably cried your eyes out, I think you have some reasons for hope.  First off, BPD is treatable--therapies like DBT and CBT can help your daughter learn how to handle her big emotions better.  Second, your daughter is very young--she can learn these skills before her negative thinking patterns and emotional reactivity become too ingrained.  She'll be getting some extra support in learning better coping skills and increasing her mental toughness!  I think there should be no shame in that, just as there should be no shame when people seek support to learn better eating habits or get physical therapy.  Third, she has your support.  I believe that the support of a loving parent (such as one who seeks advice here) is invaluable--in fact I think you are your daughter's greatest ally in the treatment journey, even if she says she hates your guts and blames you for everything.  Trust me, that's not her talking, that's BPD.

My advice?  You need to focus on self-care first and foremost.  I know that sounds counter-intuitive, but you are no good to your daughter if you are a basket case with stress and worry.  Right now your daughter needs Calm, Happy, Rational mom, not a stressed-out mess of worry, guilt and exhaustion who can barely function.  Here we call that living in a FOG of fear, obligation and guilt, which clouds our judgment.  You need to focus on self-care so that you can think straight and not get sucked into your daugher's seemingly unending drama.

My other advice?  Think in terms of baby steps.  Changing how someone thinks and behaves typically doesn't happen overnight.  If your daughter's life looks really dysfunctional right now, my advice would be to look for progress in baby steps.  For the pwBPD in my life, the first baby step was probably getting up in the morning and going to bed at a reasonable hour.

All the best to you.

[js friend]

Hi Butterflybaby,

Iam so sorry that you are here.
 
I could have written exactly what you have written when my udd was 15yo. A psychiatrist first diagnosed my udd at 14yo with Bipolar with the treatment medication of Lithum (which btw udd refused to take) and then the diagnosis was changed shortly after to an "Emerging personality Disorder" with an offer of individual and Family Therapy. Udd was aware of both diagnosis's at the time as the psychiatrist and therapist both wanted to be inclusive and I expected some resistance towards treatment as the suggestion that she may have a mental illness would have been scary for her so we agreed to at least take the therapy but udd convinced the therapist during her sessions with her that I was just and over protective parent and she wrote a final letter before closing the case that udd just growing and needed to find her place in the world.

After that we had one episode of self harm when she was 16yo. Again she shutdown and refused to speak to the pyschiatrist during an outpatient appointment after discharge.

My udd is now 32yo and we are currently estranged so I dont know much about her daily life now other than that she has a partner and I have grandkids but I can tell you that up until our estrangement nothing much had changed. The day to day chaos, the anger, the selfishness, while having high expectations of others was still there.

I think a formal medical diagnosis of any kind only works if the person acknowledges it and seeks to get the treatment or put in the the work it needs to recover or at least ease the symptoms. Your udd is still very young and although she is at an impressionable age her mind is still developing and that is the reason why personality disorders are not officially diagnosed until 18 yo so take hope.

For now I think what is important is to remember that your mental health matters too. It is so easy to get burnt out both mentally and physically with the worry and trying to change the situation that we are in but it is also important to take some time out and focus a little bit on you even if it is only for 30mins a day. I used to find that do anything that required focus was too at the time as my mind was constantly racing but something like gardening  or going for a nice walk eased my mind for a while.

[CC43]

After that we had one episode of self harm when she was 16yo. Again she shutdown and refused to speak to the pyschiatrist during an outpatient appointment after discharge.

Hi again,

The situation with the pwBPD in my life was similar--after discharge, she shut down and refused to do the recommended follow-up.  Since she was over 18, technically she could decide for herself.  Besides, I think she was convinced that everyone else was the problem, not her.  In some ways I empathized with her--she was probably sick of therapy and wanted to get back to a "normal" life.

But what happened afterwards?  She retreated to her bedroom.  Basically she spent four years rotting in that bedroom, while she avoided "real life:"  therapy, school, work, family life.  My strong opinion is that the reason she rotted in her bedroom for four years was that she was enabled.  She had her phone, laptop and internet connection.  And so she was entertained during those four years.  Though she was miserable, she was content enough to retreat from real life, and refused to work on herself.  She basically rotted in the juices of a victim mindset and hatred (directed outwardly and inwardly to herself).  She also became "nocturnal," sleeping all day (while avoiding the family), and eating junk at nighttime.  I know because I'd hear her in the kitchen several times at night, and she'd leave me a mess to clean up in the morning.  Anyway, that's the opposite of the "normal" life she professed to want, right?

My advice?  If your daughter isn't doing what she is supposed to be doing--therapy, going to school, helping with household chores, keeping her room tidy--she should NOT be rewarded with priviliges, especially a personal phone and internet access.  If I had a choice, my rule would be that a personal phone and data plan is an adult privilege, and to have one, she has to work to get one.  At least that way, she learns she has to work for what she wants--she could babysit, walk dogs, run errands for a neighbor, etc. to earn some money.  Or she could choose not to work and go without a phone.  Her choice entirely.  But what she's not doing is looking at entertaining screens all night, disrupting her sleep, retreating from facing her problems and refusing to live in the "real world," on top of refusing to work on herself.  I'm pretty sure that Dr. Phil would agree with me on this point, regardless of whether the problem were BPD, teenage rebellion, substance use disorder or other development issue.

I know, I know, the mom worry seeps in.  When your daughter finishes her therapy program, she supposedly wants to resume a normal life.  You cut her some slack, because she's been through so much.  You let her do what she wants, to keep her stable.  But the thing is, her thinking isn't straight.  By letting her do whatever she wants, both you and she are "indulging" in the aspects of BPD that end up being detrimental in the long term.  You give her an inch, she takes a mile.  In fact, if you give her an inch, she interprets that as you admitting GUILT for ruining her life.  She's REWARDED for dysfunction.  So in a perverse way, she seems to like living with dysfunction.  That is a very perilous state of affairs.

I've written this before, and I'll repeat it here.  Please do not enable your daughter to be NEETT--Not in Education, Employment, Training or Therapy.  If she's living under your roof (or in an apartment paid for by you), she needs to be working on herself, which is the opposite of NEETT.