Sister in treatment for the wrong thing

[sisbpd]

Hi everyone,

I don't know if you all have had this experience, but I find that my sister (28 yo BPD) continually seeks treatment for symptoms rather than the causes of her issues. She voluntarily checked into the local hospital and is trying to go to treatment for an eating disorder, which is a byproduct of her BPD. Last summer, my family and I had gotten to the point where we nearly secured an involuntary commitment. My parents were prepared to go before a judge and say she could not go home, because she was a danger to herself and others in the house. Then, she roped a boyfriend into getting his parents to allow her to move in.

She lived there, rent-free, for four months and has spent the months since getting back with her criminal ex (who stole from us among other offenses including armed robbery), living in a trailer with a random drug-dealing guy from Craigslist, then renting a room in a rough area and getting mugged (probably while trying to buy drugs), moving back into my folks' house and now out into a room. The boyfriend wants no part in caring for her in any way, so he convinced her 3 days after she moved into the room to seek treatment, and she has now decided her central issue is the eating disorder.

Yes, she needs to address that, but I find it is so challenging to find a place who knows how to treat a BPD patient. She is extremely manipulative, tells the therapists/ psychiatrists about 5% of the truth, and ultimately tries to get them to write her more scripts for pain meds/ psychotropic drugs/ ADD medication (she has been repeatedly evaluated and does not have signs of ADD or ADHD). I guess I am just venting, but I am trying to figure out if there is a way for her to get proper treatment so that she can sustain herself out of my parents' house. She is a danger to them when she lives with them at length and incredibly self-destructive. I want my sister to live to see her 30th birthday. I would appreciate any/ all advice. 

[Kwamina]

Welcome back sisBPD

I remember your last thread quite well in which you expressed concern about your parents possibly letting your sister move back in with them. It is very sad that your sister is having these problems as a result of her disorder.

I am trying to figure out if there is a way for her to get proper treatment so that she can sustain herself out of my parents' house. She is a danger to them when she lives with them at length and incredibly self-destructive. I want my sister to live to see her 30th birthday. I would appreciate any/ all advice.  

I think the crucial thing here would be if your sister acknowledges the full extent of her issues and is then willing to seek treatment. Unfortunately, the only way for her to change will likely be if she herself wants to change and commits to doing the work to make that change happen. Do you feel like your sister has ever truly acknowledged all her problematic behaviors? Has she ever expressed a willingness to seek targeted treatment for the full range of her issues?

[sisbpd]

Hi there,

Sorry I am just getting back to you, it's been a whirlwind. My sister never really acknowledges the root of her problems. To be fair, I think it can be hard for a person to acknowledge the root of his or her problems if they lack the perspective to do so. My sister does not have the perspective on her own life most of the time to get better, and when she does start working toward it on a good path, that fear of abandonment kicks in and she self-sabotages big-time. My parents feel they are helping her by continually taking her back in as she is in (what seems like) the billions of programs that haven't served her.

For example, I went to the hospital to visit her last night. Before I get into this you should know a few things:
1- She managed to move out on her own right before she checked herself back into the hospital for treatment.
2- My parents have planned a 4-day vacation for my husband, myself, and them the week after next at the shore. They have invited my sis in the past and she has made it abundantly clear that she will not come on family vacation unless she can drink, smoke pot, bring her boyfriend (who has stolen from us and cheated on her repeatedly). Therefore, she wasn't invited this year.

When I went to see her I found out that now my parents have offered to let her move back in when she starts her IOP- sometime next week they think. This is less than 1 week before we have non-refundable plans. I understand that this will sound uncaring of me, but for the last 5 consecutive summers my sister has been hospitalized/ coming out of the hospital days before a major vacation (my husband and I were going to Europe for a second honeymoon- just the two of us, and she almost got involuntarily committed; I planned a family 30th birthday trip, to which she was invited, and found her ODing the day before, had to rush her to the hospital and sit with her to make her drink activated charcoal, the list could go on and on). I think these vacations trigger abandonment in her big-time, but at the same time she chooses not to be a part of them, and it makes them miserable. My mom was a wreck during my whole birthday trip last year, understandably so, but it made it a horrible week after I had spent thousands of dollars and tried to plan something enjoyable.

The eating disorder is a major problem at this point- she has apparently abused laxatives to the point her bowels are not working anymore-- so I don't dispute that she needs some treatment for this, but without treatment for her BPD, I fear she will get into a cycle of recurance or substitution. I love her and truly want to see my sister happy, healthy, and independent to the extent she can be, but I fear that a combination of her seeking treatment for symptoms and my parents constantly enabling her will insure that she cannot live her life on her own, and wonder what will happen to her if my parents ever pass on.

[Kwamina]

Hi again sisBPD

The situation with your sister is quite complicated. She sadly has some very complex issues.

Stress and BPD often don't go too well together at all. Big family occasions or big events can definitely cause someone with BPD a lot of stress triggering extreme BPD behavioral responses.

Do you think that your parents truly acknowledge and accept the extent of your sister's problems? Do you perhaps feel like your parents are somewhat in denial about the severity of her issues and possibly also overestimate their own ability to help your sister?

Sorry I am just getting back to you, it's been a whirlwind.

No problem, I was just chilling in my bird's nest any way

[sisbpd]

I think my parents' heads are continuously spinning. My sister goes from one crisis to another and by the time they are through one she's had another (or more than one). I do think they overestimate their ability but my mom also suffers from depression which can make it hard for her to process a situation and act. My dad is often trying to keep the peace and keep my sister alive.

I feel for them because they should both be preparing for retirement and instead they may end up caring for her for so long that they can't retire.

My sister puts a ton of parameters on every situation. They enable it. I just pray to have both of them (and her) in my life and feel powerless.

[MiloSpiral]

Hi sisBPD,

First, let me send you a plethora of internet hugs:

           

You deserve goodness and love and I hear a lot of helplessness coming from these posts. I am so sorry you are dealing with all of this. It is very hard to have any family member with BPD, and siblings are very difficult, especially because there doesn't seem to be a whole lot of resources out there specifically targeting sibling relationships.

Your description and my own situation have a lot in common. My parents also struggle to set boundaries with my sister, who is around the same age as your sister. She has also struggled with and received treatment for an eating disorder, and like your sister she diagnoses herself with all these conditions that funamentally miss the main problems. The fact that she also things "doctors don't know anything" (her exact words) complicates the issue even further.

So, I know your pain very intimately. And that's why I'm sending you these hugs. Because it's a heartbreaking thing to watch a sibling go through, and I'm sorry.

I find it is so challenging to find a place who knows how to treat a BPD patient... .I am trying to figure out if there is a way for her to get proper treatment so that she can sustain herself out of my parents' house.

You are right that it is very hard to find treatment for BPD, specifically. Many psychiatrists are still arguing over whether or not it exists. As far as I know, the only treatment that specifically targets BPD is DBT (Dialectical Behavioral Therapy). When I did it, it was a weekly group that met for about 2 hours. The groups are often split into adults and adolescents. I don't have BPD, but I still found it helpful--DBT teaches you how to restructure your thinking, to assess situations using both emotion and logic, and to take responsibility ONLY for what you SHOULD be taking responsibility for. Even if your sister doesn't do it, it might be something good for you to look into.

I understand that this will sound uncaring of me, but for the last 5 consecutive summers my sister has been hospitalized/ coming out of the hospital days before a major vacation... .I think these vacations trigger abandonment in her big-time, but at the same time she chooses not to be a part of them, and it makes [my parents] miserable.

From the information you've given, it sounds you've judged the situation fairly. A red flag in my own mind immediately went up when I noticed the pattern of these outbursts/crises happening the day before a large event. Obviously I don't know your sister, but it sounds like an attention grab to me (as well as a desperate cry for help, whether she knows it or not).

I can understand the guilt and obligation you feel over accompanying your sister to the hospital or visiting her when she does these things. I encourage you, however, to try and unlearn that obligation if it is taxing you--to reassure yourself that just because your sister is ill does not mean you shouldn't go on the great trip you planned with your husband or family. Your time is valuable, and you have the right to give it to people who treat it as such.

Re: your parents being miserable on trips: oof. I can understand the conflicting feelings you describe in response to your mom's emotional reactions. I imagine that you feel empathy for your mother but frustration towards her as well, with perhaps a little guilt about the frustration mixed in for good measure. Does that sound accurate?

Your mother's emotions about your sister's actions are understandable and natural. Your reactions to your mother's emotions about your sister's actions are also understandable and natural. It is okay that you felt her emotional processing put a damper on the vacation: it did. That's not a judgment of her on my part, that's just a fact that you reported to me. And it's okay to not want to be privy to that emotional processing. You are as close to the situation as your parents are, and so it may not be helpful to process together. It sounds to me like your parents could use a good therapist, one who has treated BPD in the past. You don't have to be that therapist.

As you said, your parents are enabling your sister. They are parents; their instinct is to take care of their child, no matter what. But it's not helping her in the long run, as I think you've also recognized. I have the same struggle with my parents. Just this past week, after a move-out deadline had once again come and gone, I told them, "Mom, Dad, I love you and I want to support you in your decisions about Sister. I understand that I am not in your position, have never been a parent, and that it is hard to set boundaries when you are in direct contact with her. You know I've had similar struggles. However, I can no longer be the person you come to to emotionally process about the latest Sister debacle. I am too close to the situation to give you any real help, and I don't think I'm doing you, or myself, or Sister for that matter, any favors. I would strongly encourage you to seek out professional help. A therapist would be much better equipped to deal with this than I am."

What do you think would happen if you set a similar boundary with your parents?

To go a step further, what do you think would happen if you set a similar boundary with your sister? "Sister, I love you, and I want you to support you. Unfortunately, I can't do that when I see you exhibiting behaviors that I find self-destructive. It is draining on me. Besides that, I think the help you need to recover is not the kind of help I can offer you. I would strongly encourage you to seek out professional guidance. Here is a resource that may help: (give her references to DBT groups or something similar, if you're comfortable)
"In the meantime, I will not be responding to further solicitations for help, based on what I just told you. I love you very much and I hope you can understand."

She won't, but that's not the point. The point is that you set the boundary for yourself based on what is healthy for YOU, and stick to it.

What do you think?

[sisbpd]

I am really late in replying to this post, but let me just start by saying: it's gotten worse.
Over the last 2 weeks, my sister got hospitalized as a result of this last episode on vacation, my Grandpa had a stroke, she went home (convinced my folks to take her in... .AGAIN), and then OD'd again. Her friend contacted me at work, I contacted my parents, and they took her into the hospital. We all went for the initial intake/ taking her to the ER (to talk to the crisis counselor, etc).

Basically, he said the following to us:
-He thinks my sister would benefit from a residential, long-term program.
-He thinks this is VERY unlikely because of her age and the fact that she stabilizes after a few days in the psych ward. (Imagine, when she's weaned off of the million medications she doesn't needs and abuses, she's coherent!)
-He basically thinks we're in for a constant and ongoing pattern of rushing her to the ER, getting her into a psych ward, and her having a breakdown within a couple of days-weeks of her release. My mom made a point where she said that she thinks it's so frequent right now because my sister broke up with her no-good boyfriend, and when my sister is single she seems to fall apart a lot more frequently (possible co-dependency?)


I made a demand of my parents after the last vacation. We have started family therapy- my mom, dad, and I. It is important for us to learn how to communicate and to strengthen ourselves as a family, to support my sister when she's not doing well, to come together when she is, and to prepare ourselves, unfortunately, for the worst.

We were told a few years ago that the only way for her to get into a state mental hospital was through commitment or jail time. I fear it will be the latter before the former. She admitted to us in the hospital that she was on heroin again recently, but once again, does not think she has a problem. Meanwhile, she is still smoking pot, drinking, taking psychotropic drugs, depression medications, sleeping pills, Lyrica (she claims to have fibromyalgia), opiates, ativan, and barbituates. It is enough to kill a horse, and my sister is a very thin 5'5" woman.

I feel as though the social workers we're encountering are mostly concerned with booting her out of the programs. She is on Medicare/Medicaid, and it seems like since she isn't homeless and her family still shows up, they legitimately don't care about her. She came up with a plan to move out of state to live with a person she barely knows who has as many problems as her. They encouraged this (despite her actual honesty about this person's issues) and told her that it would be no problem to switch her benefits.

It turns out the friend she was moving in with did a little digging and learned that if my sister moved, it would take 1 week- 6 months to reinstate her Medicare/Medicaid in a new state. She would have similar waits for food stamps, Social Security, etc. As it stands, my sister has not been able to keep a job, hold a relationship, or stay out of the hospital for more than a month or two at a time and desperately needs these benefits. Yet, her social workers egged her on and released her sooner to help her achieve these goals, without so much as a word about these pitfalls.

To answer MiloSpiral, my parents and I are trying to establish those boundaries in our family therapy. I realize it's not healthy for me to play therapist or social worker. However, I also realize that old habits die hard. I know I need to do the work, but I also need a third party to help me figure out a compassionate way to establish boundaries that will preserve my family relationships and keep me a part of the team working to hopefully help my sister.

The therapist we're seeing works with BPD individuals all day long and has a lot of experience counseling their families.

I guess I am reaching out to see if any of you have experiences with actually getting appropriate treatment for your BPD relative. My sister's problems are multifaceted at this point (BPD, flashbacks, eating disorder, self harm, and drug abuse), however, I refuse to give up on her.

I felt like, as a family, we were being prepared that the system may allow her to die rather than helping her, and I just am starting to lose hope. My favorite job in the world is being her older sister, and I don't want to be out of a job.