BPD stress episodes

[anon3232]

My sBPD is recently getting panic episodes (thinks she's going to die and her heart's going to explode) and nightmares. She and parents went to the ER in the local state hospital a few months ago. She told everyone that she suffered them every other day. At first it seems like it's simply related to the work issues I mentioned in another thread. Then recently, she seems to be getting these episodes on a lot of other things (e.g. finances, taking the public transit). Even though she has a terrible attitude for years, this is something very new. It only really started when she moved out spring this year and I wonder if that is a coincidence or a trigger (abandonment?).

At this rate, I fear she's eventually becoming a non-functional person. Living with her is not an option for anyone in the family right now since we all agreed she's just going to make our lives a living hell. To her credit, she's seeing mental health specialists now and knows there's something very wrong with her.

I wonder if anyone has dealt with pwBPD that suffer these mental episodes and what are good resolutions.

[Notwendy]

My BPD mother has done this too- and whether or not they are real or her acting out- it's hard to know. Sadly, although my mother is intelligent, she is low functioning and coming to medical attention is her way of having a reason for this.

Regardless if these episodes are emotional, physical, faked or real- I think it's important to be realistic about a person's level of functioning. My BPD mother fit the expectations of her era- where women were not expected to work outside the home. My father supported her financially and emotionally. Her level of functioning when it came to household tasks is low too. I don't know the outcome for my mother if she had been single, and so I do see where it is scary for your sister.

Like those of us here with elderly BPD mothers- we also have to be realistic about what we can do and you do too.

It is good that your sister is being evaluated by professionals. Here is where you also need to let them know what resources your sister has. If family is willing to be her caretaker- that is the direction they will go- so you need to make yourself clear to them about what you are willing to do or not.

If you are in the US, consider seeking social security disability for your sister. If you are in another country- see what is available to her. I think we tend to look at intelligence level but if they can not translate that into actual daily function, they aren't functioning at that level and quite possibly could not hold a job or be self sufficient.

I say this not to dash your hopes but after observing my mother's level of practical daily function- I think the emotional aspect of BPD for her is significant. If your sister can qualify for any government or mental health assistance- then good.

[CC43]

Hi Anon,

Notwendy is very wise and has lots of experience dealing with BPD, especially BPD that renders a loved one to be very low functioning.

I couldn't tell from your post how old your sibling is.  Since you mention work issues and finances, I presume that she's well into adulthood.  That your sister has a history of holding down a job and managing her own finances is a very good sign in my opinion, suggesting that she's at least moderately functional.  And since you mention the recent appearance of what sounds like panic attacks, it suggests to me that those might be a temporary response to recent stressors.  (Low stress tolerance is a hallmark of BPD.)  Alternatively, panic attacks could indicate "escalation" by your sibling.  You see, a young adult might initially rely on child-like behavior, to convince parents to over-function for them, as they make the very tentative transition to full-fledged adulthood.  Think tantrums, extended unemployment, allowing parents to pay for living expenses, summer vacations, partying, staying up all night with screens, failure to fulfill commitments, and living in the proverbial parental basement.  But at some point, acting childlike might stop working, and parents might think, she's too old for this type of behavior and lifestyle, it's time for her to grow up already.  So she might shift to other, more drastic tactics to get what she thinks she wants--more support and attention.  Maybe she tries self-harming.  Maybe she tries panicking.  Maybe she invents stories of abuse.  Maybe she "goes nuclear" and threatens or attempts suicide.  It probably doesn't matter if she's faking it or not--the reality is, the behavior is self-sabotaging and/or self-destructive, while at the same time, garnering parental (or other) familial support and concern.  (She's likely lost all her friends, because they quickly tire of her behavior.)  Does everyone in the family seem to "drop everything" and run to her rescue?  Then I'd say, her escalation is extremely effective.  Why would she change?  In essence, it can turn into an EXCUSE for her low functioning.  And that, in my opinion, is the most harmful thing, because it makes her believe she's powerless over her situation.  And powerlessness eventually turns to hopelessness.

But I think that the good news is that panic attacks are a physiological phenomenon that responds to medications.  There are many conditions that sometimes co-exist with BPD, and anxiety or panic attacks is one of them.  Has your sister sought treatment for this?  My BPD stepdaughter complained about anxiety and intense emotions, and I think that medication has worked pretty well for her.  In addition, I can't help but wonder if your sister might be self-medicating with illicit drugs.  My stepdaughter's BPD symptoms--including anxiety and paranoia--got much, much worse when she used marijuana.  She had to hear it from doctors that marijuana was making things worse for her, not better, before she stopped.

Anyway, I'm thinking that your sister is reacting to increasing stressors in her life.  BPD is usually associated with low stress tolerance and impatience; and people with BPD often haven't learned healthy coping skills.  I bet she has been facing some disappointments or setbacks at work, or with her relationships.  But that's where DBT therapy can help.  In addition, I've counseled my BPD stepdaughter to focus on self-care and healthy habits when the going gets tough.  The tougher things get, the more she needs to focus on eating right, getting exercise and getting regular sleep.  I think that learning healthy habits is part of most treatment plans, though doctors might use different words for it.

Finally, maybe your sister's current work situation is too stressful for her.  But that doesn't mean that ALL work situations are too stressful.  There are millions of jobs out there, and maybe she needs to find something that's a better fit for her.  Maybe she could try something part-time, so that she can simultaneously focus on therapy while she gets herself back on track.  I happen to think that work can be a very positive force in one's life, as it can help provide structure, an identity, friendships, and, of course, money (and affordable health insurance).  Though some pursue the route of disability, I wonder if that could signal to her that she's unable, and somehow broken.  I'd say, if she is in fact moderately functional, then every effort should be made to get her back on track.  I suspect that she'd be happier in the long run living a full life.

All my best to you.

[anon3232]

Thanks for the replies.

My sister is older than 30. I deliberately smudge out some details to avoid being recognized by some one in real life.

My parents are not in a position to take care of her and I've already made clear that my help towards her will be limited to some subsidies and I will not live with her or provide for her. Yes, social security is something I have unfortunately thought of. I hope it wouldn't get to that. Her ego is already a wreck. Even though she is part of this anti-work social group who vehemently hates needing to work for a living, her shame will destroy her if she becomes a bum.

Yes, I wondered if it's a cry for attention since again it coincided with me moving out. For the most part though, we don't enable her. My parents tend to put her to her place when she's out of line. My other siblings and I also take a do-not-engage mentality. I personality do not have enough residual empathy left to give much comforting words (yes, it's pretty much all used up over the years).

No, she doesn't do drugs. She is religious and hates drugs, alcohol, and other stuff generally considered naughty.

Yes, I am probably going to take a more active role in checking out what she's really getting out of her mental health treatment. She's still not on DBT despite that being mentioned to her.

[Notwendy]

While I believe you have every right to move out on your own and have your own life, I think your moving out was a significant stressor. One aspect of my BPD mother's anxiety is that she isn't able to tolerate being alone for a longer period of time. Even if I went to the store with my father, she'd call his cell multiple times when we were out. "when are you coming back".

I didn't understand this as a teen but sometimes if I was at a friend's house, my mother would call and say I had to come home- but there wasn't any reason. I thought maybe they didn't trust me? But I wasn't doing anything wrong. I think it was because she wanted someone there at the house.

She's in assisted living now but she has her own room and sometimes she will call me up in a panic- and I will try to "talk her down" from her fears. It's like her own thoughts get out of control and then her feelings.

With my mother, I have seen her anxiety and behaviors escalate during changes.

The going on disability is a big decision and not for everyone. BPD is a spectrum. I think it is better to be employed. It's different now for women- they have opportunities and also expectations in the workforce. I just know that my mother's functioning even with daily tasks is stressful for her.

In time, your sister may adjust to the new living situation but another option might be some sort of apartment living where there are other people around. A room mate situation might be problematic. My mother was in skilled nursing for a while after an illness and in a private room at first (due to her being contageous) but after that, a double room. She did not like the shared room but the social worker there noticed she behaved better and seemed calmer when another person was there.

[Strawberry29]

Hi anon,

I have had a similar experience with my sibling, who started having repeated panic attacks few months back. He was initially putting the blame on something he was fussed about at the moment, and that he said was causing him breathing problems, but it was super clear to me it was panic attacks. He then admitted it and put the blame for the attacks on me…

With him, I think it was an escalation of his situation. There was probably some triggering factor, but these days I am finding out there are times when if the trigger is not something, it will be something else… it s kind of unavoidable.
Good that your sister seems ready to try and seek treatment. That might really help, it is for the moment with my brother since he finally started seeing a therapist again. He s had no attacks lately.
I hope things can get better for you, your sister and your family!

[anon3232]

No, I don't think it's be possible to live with a roommate or housemate. She's a germophobe, a control freak, and not good with boundaries. It would be disastrous for both her and the other person.

Yes, the last sibling of hers moving out could be a trigger. Despite being difficult to live with, she also doesn't like to be being alone.

She does live beyond her means in the sense that it's a bungalow that's bigger than she can afford (it's my dad's) and she's paying all the utilities (no rent). We do help her out a bit by paying for all the stuff whenever we are out together and also a little subsidy per month. She pondered about moving and also felt stressed about it because renting even an apartment is more expenses than status quo. If she is to buy a house (with lots of help from the entire family), she is also stressed about the prospect of mortgage. She also doesn't want to live outside of a convenient neighborhood (which is expensive) and have lots of demands on what her new place should be. None of which she can afford. Living in a big house for most of her life spoiled her and she's now caught in a situation where she doesn't like the status quo and also doesn't want to work towards a change for her living conditions. My siblings and I all downgraded to much smaller places (1 or 2-bedroom apartments) but we don't have all these issues with making sacrifices etc.

Strawberry29, how did you and your brother deal manage those panic attacks? I wonder what lessons I can take from you.

[Strawberry29]

Not sure there is much that you can learn from me, to be honest, because of the situation: I haven't seen my brother in over 2 years, he avoids me like if I was the bubonic plague in real life, but he keeps texting me constantly.
When those attacks happened, it was always at night, when we were all sleeping. He called the ambulance to go and take him a couple of times, but my parents didn't even notice (he left home before the ambulance crew rang the bell) and he texted me but I live away and keep the phone off while asleep.

The best I could do was really just to say obvious stuff like "I hope you feel better, the doctors will be able to help you, hopefully it's nothing serious" when I woke up, but he of course thought it was not enough. What he wanted me to say was something like "I am sorry, it is 100% my fault if you had panic attacks and from now on I will do everything you ask me to do".

I think, though, that those attacks scared him like hell, and they are one of the main reasons for him finally seeking treatment again. He is a bit hypocondriac, so anything health related can lead him to do stuff he wouldn't otherwise.

[Notwendy]

The reason I bring up disability is that- BPD is a spectrum and at the lower functioning level- a person may need more supports than we may assume. At the same time, it's also important to have a person function at the best of their ability- and not hinder them. We think about this when a person has autism, or Down syndrome. Help them to function at their best while also making sure supports are in place for them if they need them. Yet this kind of thinking is in place for people with a disability or difference and not for pwBPD.

With BPD there are behavior issues and anxiety that are challenges. But so is there with autism and it's often the anxiety that has an impact on function. When someone has controlling behavior, or OCD, or something like germophobe- it's driven by their anxiety.

If your sister is living rent free in a home, that is probably her most economic and it seems best- situation, even with the utilities. As to not being happy with her situation- this is a constant with my mother, no matter where she has lived and so likely- if your sister moved, it won't make her happy either.

I think we tend to both overestimate and underestimate a pwBPD's ability. I think it's great that your sister has come to the attention of mental health professionals. As for now, your sister has shelter and her basic needs met. She may be a combination of both able to do some kind of employment and also being partially dependent, or she may be able to be independent. Hopefully the mental health assessment will be helpful.