The challenges of getting a teen properly diagnosed and treated

[2girls3canines]

We just returned from meeting with a child psychiatrist to see if dd had a diagnosis or needed medication to augment her DBT. He met with all of us together and then dd individually - when we all returned to the room, he said he thinks she has some depression and could benefit from Zoloft.

Maybe I am wrong and depression is the only diagnoses - but dd meets all the criteria for BPD except that she has never has never expressed an suicidal tendencies or self mutiliation(for which I am grateful)

Because she has had the same symptoms for at least 10 years that I can remember, I asked if he thought the depression had been going on that long. He said yes - that it could have been growing and growing all these years and that is what is causing the rage, verbal and physical aggression at home only, the inability to form and keep any relationship, the blaming others for all of her problems, etc.

When I told him about the DBT and that it seems geared towards so many of her problems and that is why we wondered if might she have BPD, he said she was too young to have that. I even told him that I felt like he wasn't seeing the gravity of our situation - because I truly did not feel like depression was the "problem" - it is just a symptom of a larger problem.

I agreed to the Zoloft as dd wanted to try anything to stop this roller coaster she lives on. I am hopeful it will help, but am afraid it is simply a bandaid.

Could I really be wrong and it is simply depression? And if that is what it is - why wouldn't her last 3 therapists have suggested she was so depressed.

I am feeling so frustrated...

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

[Healing4Ever]

I empathize with your frustration!  It is hard enough dealing with the behaviors, and wanting the best for our children, to then also have to deal with the uncertainty of what we're dealing with, along with not feeling validated for our own intuitive understanding of our children's problems.

Is it possible to get another opinion?  I would guess your dd is likely not wanting to continue telling her story over and over again (that is how my dd17 feels), so I often feel desperate hoping that *this* person will have the answers and save us from running all around.  I have advocated for my dd to see a psychiatrist specializing in adolescents as well - I wasn't happy just starting her on antidepressants from the family doctor without a better evaluation of her symptoms.  But, I'm also wary of what that psych will say - each mental health professional has had vastly differing opinions - that oscillated from admitting her to a psych ward, to just using CBT, to having major depression, to starting antidepressants and not really including me (her mother) unless I step up and assert myself.  And lots of holes in the system - if I weren't advocating for her, nobody is actively following up with her, and yet I'm not entitled to her health info since she's over the age of 16.  Huh?  The system is broken if they think that a 17 year old with mental health challenges can navigate for themselves.  Anyways... .I digress... .

If your dd wants to try the meds... .would it be worth seeing how they work as you aim for another opinion?  Sometimes a person's reaction to the meds can help to fine tune the diagnosis, I believe. 

I can't comment on whether it can be just depression vs. BPD as I'm also new to all of this and wonder the same thing about my daughter - she has self-harmed and had suicidal ideation, and her grandmother has BPD and certainly I grew up with it.  However, my dd's symptoms flared this past spring, so I haven't seen it for 10 years.

Hugs to you and keep up the great work advocating and looking for the best answers!


H4E

[2girls3canines]

thanks. She wanted to try to zoloft, she that is what we agreed to do. We will f/u in 4 weeks to evaluate the meds. I guess we could get another opinion, but dd is really tired of talking about all her problems - she just wants them to stop ( they are usually my fault anyway - right?)

She got mad today and is back to the silent treatment because we sent the morning taking about her moods and rages and how it interferes with her own life and our home life. She got mad when we left the dr office because I didn't tell him all the things her dad and I do - and that I didn't tell him on purpose. I reminded her that we were there to help her and she was encouraged during the appt to speak up and say something if we omitted it or she thought it was important…

I am also starting some 5 HTP and omega 3 supplements - which we were told were fine with the Focalin XR and Zoloft... Hopefully these meds and the DBT will be helpful.

If not, when we f/u next month - he is either going to have to be more open minded, or we will get another opinion.

[Skip]

I, too, empathize with your frustrations.

The leading experts on borderline personality disorder initially defined the disorder such that the patient had to be over 18 qualify for diagnosis of BPD.  Most psychiatrists in this area were trained this way.

More recently, experts at Harvard University have begun to diagnose teenagers with the disorder.   Here's a video from Blaise Aguirre, a leading expert in adolescent BPD, speaking about this issue.   In his presentation he describes one adolescent with BPD characteristics and yet, even he admits that he did not diagnose this patient with the disorder.   My point is, that even in the most liberal clinical setting, there is a significant threshold that differentiates "diagnosed borderline personality disorder" from traits of BPD.  This is a really helpful video: https://bpdfamily.blogspot.com/2013/05/bpdfamily.html

From my own understanding of the diagnostic and treatment practices, psychiatrists tend to treat the easiest treatable symptoms in patients in first. If that works, great. If it doesn't work, then they start looking for more complex conditions. So a progression may look like this... .diagnose and treat for depression (simple  antidepressant, some therapy, $), if not successful diagnose and treated for bipolar disorder (potent Bipolar meds, some therapy, $$), if not successful diagnose and treat as borderline personality disorder (complex therapy with some drug assistance, $$$$$).   In a lot of ways, this makes sense.   Psychiatry, in general, is not a very exact science and treatment is often a bit of trial and error.

At this point, from a medication point of view, do you feel that her prior treatment has show that she is not responsive to a simple or a more treatable condition?  If you do, that might be the best place start with the psychiatrist.

[almostvegan]

There seems to be some debate as to how old is old enough for a BPD diagnosis. My daughter was given a definitive dx at age 15. She was symptomatic for years and every piece for the puzzle. BPD is a life long condition and drs don't like to label a mind until its stopped developing. However in my daughters case it was so clear this is what she has that to ignore it was ridiculous.

Truth is that it doesn't really matter what you call it. The symptoms have to be treated thought the underlying cause may remain.

I hope for you and your child that depression is " all" she's got. Treat that and life gets soo much lighter. I will keep you in my thoughts and hope that your family will be more peaceful soon.  I know how stressing depression is. I wish you the best.

AV

[2girls3canines]

she has not been treated with medication (other than for adhd) before. I guess my frustration is because she has been symptomatic for years and he seemed to focus only on the depression and that the zoloft "may" help improve the other symptoms as well…

At this point, while a diagnosis would be helpful, we just want the symptoms to stop so she can live a happier life and have relationships with family and a few friends…

[modafinilguy]

Bah. If she has BPD, the research shows antidepressants are really not useful at all!

Worth a try I guess, but I wouldn't get my hopes up.

Read up ADHD, 25% of people with BPD have it, but frequently NOT diagnosed. If she has ADHD (read the symptoms carefully) then treatment for BOTH disorders (medication for ADHD) could change everything dramatically. You may have to get another doctor though.

[crumblingdad]

I certainly wouldn't make a diagnosis for a teenager without a competent psychiatrist.  However, the amount of reading I've done on adolescent BPD has shown clear indications that diagnosing it in teens is now something that most true experts in the field now accept. Unfortunately most in the psychiatric world have shyed away from BPD and continue to live by the past theories that it cannot be diagnosed before age of 18.

So with that said you commented that your psych said she's too young to have BPD.  My question to him would be "do you believe a child under 18 can be diagnosed with BPD."  If a psychiatrist answers yes to me on that question, then right wrong or indifferent, it is my litmus test on whether they should be treating someone who potentially is borderline.

I just feel that research and information on BPD in adolescence has progressed far enough at this point that anyone who rules it out as a possibility is probably not someone who's kept up with educating them-self on the topic sufficiently.

[Skip]

When AIDs first became a problem in the US, community based (non-University) healthcare  was very slow to come up to speed.  It was actually education in the gay community and their challenging of physicians that expedited the education of the providers.

Don't be afraid to ask your doc about an article that you read and give him a copy... .ask him for help to understand what you are learning.

[BioAdoptMom3]

How old is your DD?  Ours if 14 and when we first sought treatment when she was 11 1/2 she too was diagnosed with depression, along with panic disorder, generalized anxiety and social anxiety disorder.  Our DD does self harm, has bulimia and suicide ideation in addition to the relationship issues your DD has.  I have been told by her psychiatrist now that though she is too young to offically diagnose, they did diagnose her with the traits and are providing therapy as if she has BPD.  However it took about 2 years until they were willing to say that, so a more difinitive diagnosis for your DD may be down the road, but I think when they are young the doctors and therapists like to work with them for awhile before jumping to conclusions. As for the Zoloft, anti-depressants have helped our DD, along with Abilify which is a mood stabilizer.  Ours was placed on Prozac and we noticed a difference for the better pretty quickly.  However she leveled out and they ended up increasing the dosage, and later adding the MS, which made a big difference.  I think Zoloft is a good idea for now, at least see how it works for her.  If you don't notice a difference at all after a month, or she cannot tolerate it, there are lots of others out there to try.  It does take the edge off for them so to speak.

Good luck and lots of