Difficulty in child/teen diagnoses

[Elfie]

  I'm a bit new here - as a brief intro, I have an uBPD brother, 19. I'm several years older than he is and have been trying to help my parents cope and learn more about helping their son/my brother.

One thing that I keep getting a bit "stuck" on is wondering if my brother will ever get a BPD diagnoses (or any other real diagnosis besides the ADHD, anger issues, sensitivity, and depression ones that have been thrown at him when he was younger) and thus be able to be "treated" for it, by whatever means deemed appropriate. I know it can be difficult for people in general to get a BPD diagnosis, and it's even harder for teens/young adults, in my understanding. It's made more complicated by the fact that my brother will not voluntarily go to any kind of treatment, and as he's over 18, there's little my parents feel they can really do to make him.

However, as much as my brother will deny he has issues or that he needs help, there are other times where he does seemingly admit that he has issues (mostly that he feels depressed and sad and hopeless - but he won't take his prescribed antidepressants). It's very hard for me (and my parents) to watch him struggle so much, and feel that we perhaps have this "answer" as to why he's going through what he's going through (BPD) - but we can't tell him about it (I don't think he would react well), and it seems like it would be very difficult to get him to see a good therapist, much less get a real diagnosis (would that even be helpful to him?).

Can anyone relate?   


As a sort of brief mash-up of his "symptoms" - his "avoiding abandonment" responses seem to center around him doing accusations/raging/acting like he doesn't care when he feels that others are "abandoning" him in any way. He has a very intense/unstable relationship with his current on-and-off girlfriend (massively emotional breakups where police are called, and then fine the next day; not able to break out of the relationship). He seems to have little sense of self and "needs" to be around friends (usually bad choices) to gain a sense of identity. He is very impulsive and has poor decision making skills; he seems to want to constantly create chaos. He abuses drugs and alcohol and overspends. He sometimes self-harms and threatens suicide. His moods are very unstable, varying minute-by-minute sometimes. He definitely is a black-and-white thinker. He can go into rages where he yells, curses, and acts violent. He also has periods where he seems very "low" and empty-feeling, even to the point of dissociating (zoning out). He remembers things "wrong" or that other people wouldn't remember. Other traits mentioned in the SWOE workbook (difficulty being alone, feelings of guilt/shame, poor object relations, poor boundaries, control issues, very competent/intelligent in some areas and not in others, narcissism, and manipulation/lying) also fit him to a "T". He has had numerous "run ins" with the law and has been jailed several times and on parole a few times (currently, in fact).

Would this all be worth bringing forward to a family therapist sort of person? Sometimes I feel like the crazy one - he can seem almost "normal" once in a while. But not usually. Does he sound like a pwBPD to those more knowledgeable here?

I guess we're mostly feeling overwhelmed, and not sure where to go from here, what actions we can take.

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

[cfh]

Ellfie

Your brother sounds exactly like my son(29) who has been diagnosed with BPD and also with ADHD, ODD, polysubstance abuse,  PTSD, maybe ASPD... .  so many letters. He is currently in jail. 

So yes your brother seems to have traits of a pwBPD.

I may not be the best person to offer advice as I am a bit overwhelmed myself right now.

But so many wonderful people on this board will have ideas for you.

You are a very caring sister and your parents and you want to help your brother and it is so very difficult. Hang in there. You all need to take care of yourselves too.

Keep posting.  This is a great board.

[opheliasmom]

Elfie,

I have to echo Cfh.  Your brother sounds just like my diagnosed dwBPD.  She also has ADHD and polysubstance abuse.  She is 19 and I can't make her see her therapist any more.  She does know she has serious problems, but  does not want to get help.  She just wants to be normal. Instantly, without any work.

If your brother won't seek help you and your parents can.  If you do decide to go to a family therapist you may want to find one who has treated someone with BPD.  Someone who is familiar with DBT.  I interviewed several different therapists before I could even find one who knew what DBT was.  I think because we are in a rural area the resources are slim.  I don't know where your are, but NAMI is a good resource.  It sounds like you are trying to figure all of this out and help your brother which is awesome.  You also need to take care of yourself.  Setting boundaries may be another important step for your family.  Best wishes.

[Elfie]

Thanks so much for the input, cfh and opheliasmom. It helps to get more perspective and thoughts!

My brother hasn't been "official labeled" as having anything as far as I know except for possibly the depression (I guess he'd have to be "diagnosed" for them to put him on meds); I don't think he actually has ADHD, but that was thrown around when he was younger as a possibility to explain his various behaviors (very active, defiant, throwing tantrums, sensitive, kinesthetic learner, "hyperactivity" symptoms, talkative). He's (obviously, I guess) fairly secretive about the self-harm and substance abuse. I know he smokes pot (he's gotten arrested for this, and for selling) and has used synthetic weed and ecstasy (probably others, as well). He also smokes cigarettes and hookah (at least they're legal) - but it's like he has some kind of addictive personality that compels him to pick up a bunch of these substances/impulses at once. He somehow can't manage to save or handle money despite my parents teaching good habits. (He does not live at home and is on probation in another county at this point)

I will try to talk to my parents about possible family therapy - maybe through NIMH, church, even Al-Anon - I think just *something* would be good. My brother has a tendency to throw wrenches (chaos) into things, so any time things seem to be going smoothly or at least okay, something will happen (most recently, he decided impulsively that it was a good idea to send, in her words, "disrespectful" texts to his girlfriend's mom about how her daughter was acting - and of course, her dad is a cop and immediately started threatening brother with legal action [overreaction on his part, too, but still]).

[cfh]

Elfie

Oh dear your brother is sounding more and more like my ds.  The money thing is almost always a problem for pwBPD. 

Unless you live in a very rural area your local NAMI affiliate (as opheliasmom said) should be giving a 12 week course called Family to Family.  It would be great if you and your parents could take it together.  My dh and I found it so helpful.

Others on this board have had good experiences with Al-Anon.

I think anything you can do for yourself would be wonderful... .  and in the long run will be helpful to your brother.