First post- teenage daughter recently diagnosed Bpd

[BookNerd]

This is my first post so “hello” to everyone. My daughter (15) was diagnosed or at least strongly suspected by her psychiatrist and therapists to have borderline personality disorder. We already were treating ADHD, PTSD (from foster care with her biological family) and a depressive episode that sent her to the hospital for a few hours. But at the new year she started having episodes where she would refuse to speak, be irrationally angry and her peer/romantic relationships got more dramatic. She refuses to eat and admitted that it’s part of a desire to slip away. She will sometimes binge eat in the middle of the night. She searches for connection with people online or boys at school that don’t seems to care about her. She self harms. She can be a child who is so fun and lively but recently I rarely see her. She texts me all day from school angry and sad about the other kids at school. Not wanting to go to school and hiding in the bathroom. I’m at a loss. She’s in therapy but still working on connecting. She takes medication, has an IEP and support at school and two parents that are really trying. The evenings are the worst. I’m overwhelmed. I’m afraid for the future and feel isolated and ashamed. Right now she’s shut down and refusing to speak. I think she’s only had a couple of mouthfuls of food in 24 hours. She’s on spring break but doesn’t want to go back to school. She’s burned so many bridges with her peers.

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

[CC43]

Hi there,

Welcome to the family.  I have no doubt that you've had it really rough, and you're probably wondering how you can continue on like this.

First off, you should know that BPD is treatable.  Learning that was a huge relief to me, when I found out that my stepdaughter had BPD.  The complication is that treatment consists of therapy, and for therapy to work, the person with BPD has to want to change in order to start to feel better.  But when it's a child or young adult with BPD, the tendency is to blame parents for all the problems in her life.  Though she'll also blame siblings, friends, roommates or co-workers, at the end of the day, it's the parents who typically support her the most, and so they are the ones who are the object of her wrath.  Over time, she can become shackled by a pervasively negative, victim attitude.  My opinion is that this is the toughest part of BPD, because it renders her helpless.  In fact, it's a learned helplessness.  When parents step up to ease her pain and shield her from negative consequences, they unwittingly tend to reward and reinforce her negative, self-sabotaging behaviors.  At the end of the day, she thinks her parents are the ones who have to change, not her.  And so she might resist therapy, unless the therapist allows her to bash her parents non-stop.

Secondly, BPD often comes with co-existing conditions, which might include PTSD, anxiety, depression, addictions or eating disorders.  That surely complicates treatment.  The good news is that anxiety and depression might be treated with medications.  I imagine that some doctors will diagnose anxiety and/or depression, because it's easier to treat and doesn't come with the potential stigma that BPD might have.  But in your case, I think it can be considered a positive development to have a BPD diagnosis, because then you understand better what you're dealing with.  After reading these boards, you'll see it's unusual to get a BPD diagnosis until adulthood.

I'm not sure how to advise you, because I don't have experience with BPD in someone so young.  But my opinion is that getting treatment while she's young is probably best, because it could shorten the amount of your daughter's suffering, and by extension, the suffering of the entire family.

I found that it helped me to think about BPD in terms of an emotional age.  I estimate that my stepdaughter had an emotional age of around 70% of her chronological age.  So at 19, she was functioning like a 13-year-old, emotionally speaking.  My stepdaughter just couldn't handle much pressure, be patient, have empathy for others, put things in perspective, or plan for the long term, for example.  She remained very demanding and needy, including needing to be the center of attention.  She couldn't handle the rigor of college, let alone study for long hours in a self-guided fashion.  She couldn't find the discipline to go to bed at a reasonable hour, get up in the mornings and take daily showers.  She didn't like (or want) all the responsibilities that go along with young adulthood, and she simply crumbled.  When adding peer pressure and social media, she was completely overwhelmed.  She was easily "triggered" by any perceived slight, and she just couldn't rebound from setbacks. I think she felt she was traumatized all the time, and she developed a trauma-like, fight or flight response to ordinary daily stressors.  She'd see-saw between raging fights and flight, which manifested as avoidance and cutting people out of her life.  With all that emotional baggage, it's no wonder she was falling apart.  And when she fell apart, she fell behind her peers, which only reinforced her misery.  To cope, she'd lash out at everyone, lose her friends and then hole up, alone and alienated, wallowing in a pit of despair.  She talked all the time of wanting to end her life, and she tried to do that a few times.  Not fun.

Anyway, by thinking in terms of emotional age, it was clear to me that my stepdaughter was set up to fail.  But by adjusting expectations, providing extra support and proceeding in baby steps, along with therapy, she managed to turn things around.  I'm happy to say that today, I don't believe she'd qualify for a BPD diagnosis, because her behaviors (self-harm, depression/hopelessness/emptiness, inappropriate anger, periods of delusions/disassociation, unstable sense of self, extremely volatile relationships) are mostly resolved for the time being.  Though she's still plagued by volatile emotions, the frequency, intensity and duration of her outbursts are much reduced, and she doesn't completely fly off the rails like she used to.  Best of all, she's looking forward now, instead of always looking backwards, stuck in a rut of negative childhood memories.  Her progress has been remarkable, and though she might still be a bit behind her peers and siblings, and she hasn't repaired all her familial relationships yet, she's heading in the right direction.  For me, the positive direction of movement is more important than speed.

Since your daughter has many confounding behaviors, I guess my advice would be to focus on one thing at a time.  Think in terms of baby steps.  Change is hard, so I think you need to prioritize and break things into smaller chunks, until a good habit is established.  You might ask her doctors what to prioritize first.  I will say that for my stepdaughter, doctors recommended following a healthy routine, as well as DBT therapy.  I think that because people with BPD are so easily triggered, having a strong and healthy routine can actually feel comforting.  For my stepdaughter, that included establishing basic healthy habits like going to bed and getting up at a consistent hour.  I think that when she was untreated for BPD, she would lie awake most of the night consuming social media, feel groggy all day and miss meals, which meant she was snacking almost exclusively on junk food.  (When I eat crap even for one day, I feel like crap, and so I think she must have felt terrible living on sweets, soda and chips, which exacerbated her acne, a secondary issue for her).  Looking back, I wish my husband had allowed me to cut off wifi and phone use during nighttime for the entire family, to encourage better sleep routines, for starters.  My stepdaughter must have felt like she had jet lag, stomach aches and hunger pangs every day.  If hunger makes me short-tempered and angry, I imagine that for someone with BPD, those negative feelings would probably be super-sized.  Now, I'm not implying that a healthy routine will cure BPD.  But I am saying that establishing a healthy routine was an important first step for my BPD stepdaughter, and it was so important that it merited some focus for a while. 

In summary, when my stepdaughter began her road to recovery, her first baby step was to focus exclusively on therapy.  After being released from an intensive therapeutic program, her next baby step was to focus on establishing a healthy daily routine, including regular sleep, healthy eating and getting outside for exercise on a regular basis, while maintaining her therapy appointments.  Only after she had the basics down did she add another baby step, which was to take an online course.  We didn't expect her to handle a full course load at first, because I think that would have set her up to fail.  She had to demonstrate that she could handle some pressure before adding commitments/responsibilities to her schedule.

My other advice would be to prioritize your own self care.  You're no help to your daughter if you are a basket case.  In fact, I think you should model what a healthy adult's life looks like, and that includes taking care of yourself, including therapy for you if you think that would help.  Treating BPD is a marathon, and you will need support, too.  You can find some sympathetic listeners on this site.

All my best to you.

[BookNerd]

Thank you, a lot of what you said resonates with me. I appreciate the advice and feedback!