Long post- adult daughter

[Real Tired Mama]

Hi all. New here. I am usually very long winded so I'll TRY to make it long story shorter...

Backstory: My 20yo DD has been hospitalized 3x now. 2023, 2024, & now 2025. Each time almost exactly one year apart. The first two times the psychiatrist told me her diagnosis was "THC induced psychosis" upon discharge. I don't agree with my DD recreational use & she knows that. So she has never done it around me, but when she has these "episodes" once a year (idk what else to call it) She goes from being a caring, loving, hard working, young adult to mind racing, hyper focused on irrational ideas, constant outburst on people closest to her, audible hallucinations (she thinks people are screaming when they are not & asking others around her if they can hear it) & there is absolutely no reasoning with her in the flip of a switch. She spews hateful things at those who love her & makes allegations against people currently in her life & also people she hasn't talked to in YEARS. She also makes up these elaborate stories about people saying things that they NEVER said. I do not engage, but once she is in this state of mind there is no return until she is hospitalized/medicated (I'm realizing this now. In hindsight) After her last stay I tried my hardest to keep her going for aftercare. After a few months she refused to continue & was getting upset at me for continously asking about appointments, updates, etc. She did okay with no "episodes" for a year each time. Everything was going fine, until is wasn't again...

Recent: The first of June we were on a cruise. We had been on the ship for 3 days & suddenly a switch flipped again. I was trying my best to contain it being we were on a ship in the middle of the ocean. After 2 days of me trying to contain it myself she ran into the hallway out of control & was apprehended by ship security. She was screaming at them, asking if they could hear it. They took her to medical on ship. She had to stay in medical overnight for observation. I agreed with medical it was not safe for her continue & we had to disembark early at the next port. She was taken by ambulance to the hospital there. After she was released from the hospital there we came back home where I continued to try & calm her, validate her feelings, just listen. The following Monday is when I realized she needed to go back into the hospital as it seemed things were only getting worse & not better. I was trying to avoid that because it really puts her in distress, but I also knew at this point there was no other options. She has been inpatient a week today.

Now: She is supposed to be discharged today.... to say I am nervous about that would be an understatement. I can tell by her phone calls throughout the week she is in a MUCH better state of mind now. (The 2nd day she told me she wasnt going to talk to me anymore bc I told her no when she screamed at me on the phone to come get her, but she called & apologized the next day. I'm assuming she was stabilizing & realized I wasn'tsay no to be mean) I have a list of questions to ask her doctor. In my UNprofessional medical opinion this is not THC induced, but an ongoing mental illness that she is using marijuana to self medicate with & it is masking it. When she doesn't have it (not sure about 2023, but I know for a fact in 2024 she was trying to stop smoking when she had to be hospitalized bc she told me she was after she was stabilized & obviously she didn't have it on the ship) is when these "episodes" happen... I plan to ask the doctor their opinion today & I have a list of other questions I will ask too.

Oh & the icing on the cake: first I do NOT blame him at all. He is a good guy, but her boyfriend called me yesterday & said he plans to break up with her when she gets out. It's just too much for him. She said some hateful things to him as well. They have only been dating for about 6 months. He said they may be able to work it out eventually, but he can't risk his own mental health until he knows she is going to continue with aftercare. That alone BREAKS my heart for her (&him) bc I know that is going to crush her in her already fragile state... however, I understand where he is coming from too.

Sooooo I wrote a book ugh. If you made it this far, thank you!  If this sounds similar to what you've experienced could you please reply with tips, suggestions, just your experience to know I'm not alone? Has your childs doctor ever dismissed diagnosing an actual mental illness because they think it's just due to recreational drug use?! I am DESPERATE.

Side note: I am one tired mama. I also have 2 other younger children. I've had a splitting headache since Monday going though all this with her. I have severe anxiety, but I do have medications I take as needed, but I try to take them sparingly. . I hate to even mention MY issues bc I can only imagine what she's been through & goes through when she's in this state of mind.

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,

I'm sorry tired mom, you've had it rough.  With three hospitalizations and no clear answers, you must be worried sick, on top of feeling despondent and exhausted.

Much of what you wrote, I could have written about my diagnosed BPD stepdaughter, who was also hospitalized several times, and two of those occasions included psychosis.  She had all sorts of elaborate, highly distorted stories about how everyone in her life was abusing or bullying her, from siblings, parents, roommates, ex-besties, co-workers and romantic interests.  It's as if she found trauma everywhere she went.  She would lash out in a rage over the smallest incident.  I think she was self-medicating with marijuana, and like you, I did not approve.  I'm not sure you can be confident that your daughter wasn't using on the ship, because marijuana is everywhere, and vaping and gummies are easier to hide (and, I might add, easier to consume in excess, too).  Like your daughter, my stepdaughter seemed to improve rapidly when in a hospital setting, where sleep hours were enforced, medications (if any) were administered, and marijuana wasn't allowed.  And yet, my stepdaughter had to hear it from doctors to be convinced that marijuana made her feel worse, not better, especially when it came to holding delusional, and sometimes psychotic, beliefs.  There were times she felt that others were "out to get her" or trying to harm her.  Looking back, I think her brain was projecting her own thoughts of inflicting harm onto other people.

The good news is that my stepdaughter eventually decided to heed the doctors' advice about treating BPD, even if she didn't like (or fully agree with) the diagnosis.  Nevertheless, she seemed to warm to the notion of getting professional help, to help her deal with what she felt was a traumatic upbringing, and to overcome various "abusive" relationships.  I'm putting quotation marks here because I think that her disordered thinking made her see abuse and persecution everywhere she looked.  But her treatment team must have been astute, by validating her victim narrative while at the same time helping her to move past it, and helping her learn to adopt more positive coping skills and thinking patterns.  She still hasn't abandoned her victim narrative, but she's not dwelling on it full-time anymore, either.  She's looking forwards more than looking backwards now, and for that I'm very grateful.

Like your daughter, my stepdaughter's "episodes" seemed to be seasonal.  My stepdaughter tended to be relatively stable in summertime, even if (and maybe because) she didn't do much of anything.  Summers might have been bearable because she could escape to the beach now and then, and she could look forward to the back-to-school season in September.  But the rest of the year tended to be tough for her, because the rest of the year involved increased stress.  The first wave of college assignments and midterms in October were stressful and typically triggered some sort of meltdown or crisis.  Then the holiday season was a tinderbox, because my stepdaughter couldn't bear to see others be joyful, when she felt comparatively miserable.  January and February would be spent in avoidance mode and reeling from supposed transgressions over the holidays; moreover, in the northeast US, those months tend to be cold and dark.  In March she'd perk up for spring break, even if she wasn't in college.  Shortly thereafter, she'd fall apart again, maybe because she was reminded of how wonderful her peers' lives seemed to be, whereas she felt miserable.  April and May would typically feel like a crisis time.  And then summer would roll around again, and she'd stabilize, if only to wait and bide her time in low-level misery until starting something new in the fall.

In reading your post, I can't help but wonder if your daughter might have been excited to go on a cruise with you.  But, if she has BPD, her ultra-high expectations probably weren't met.  Moreover, travel can be difficult, if only because routines are disrupted, delays are common, and people have to endure a little discomfort.  In other words, travel involves increased stress, and stress can often feel unbearable for pwBPD.  Would you say your daughter has low tolerance for frustration, and that her reactions to frustration seem inappropriate to the situation?  That could be a sign of BPD.  A cruise setting might be extra challenging for her, as there's no easy way to escape in private and have some down time.  Furthermore, if you showed some excitement while on the cruise, your daughter might have interpreted that as you enjoying something MORE than you enjoy her.  Even if you were with her all the time, your attention might have been temporarily focused on something else, and she could have felt ignored, slighted or abandoned in the moment.  Another possibility is that she thought your excitement was FAKE, because she doesn't enjoy much of anything, and she not only felt left out, but that you were trying to rub it in and make her feel even worse.  That is typical BPD, in my opinion.  Does that ring any bells for you?  Does your daughter yell things like, "This is so BORING/STUPID!" and embarrass you in front of others because of her rudeness?  That's the sort of thing my stepdaughter would do when she was untreated.

Look, it's possible that your daughter has THC-induced psychosis, AND BPD at the same time.  They are not mutually exclusive.    In fact, after reading these boards you might see that BPD often presents with co-existing conditions, including substance abuse (often of the self-medicating kind), anxiety, depression or eating disorders.  It may be that OCD or being on the autism spectrum could play a role, too, though I tend to think that those issues tend emerge at an early age.

I'll wrap up by saying that you are probably your daughter's biggest ally.  She needs you, in my opinion, especially if she has BPD.  I think it would be helpful for you to try to collaborate with her treatment team.  If she consents to giving you access to her medical data, I think that could be a big help, as you would be clued into what's going on with her.  I'm not saying that you should sit in on all her therapy sessions or destroy the trust that your daughter develops with her therapist.  But having a dialogue with her treatment team at critical junctures could be helpful.  The caveat is that your daughter has to want to accept the help so that she can start to feel better.  If she has BPD, the good news is that it is treatable, if your daughter is willing to make some changes to feel better.  She's young, she could turn things around, maybe even quickly, if she's willing to do the work.  My stepdaughter did that, and today I doubt she'd qualify for a BPD diagnosis, as her BPD behaviors (self harm, feelings of utter emptiness/hopelessness, disordered thinking, feelings of worthlessness, unstable sense of self, inappropriate angry outbursts, broken relationships, disassociation/delusions/psychosis, troubling/constant ruminations) have disappeared or diminished enough to be manageable.

All my best to you.  Hang in there, and don't forget to take care of yourself.  You're no good to your daughter if you are a complete wreck.

[Real Tired Mama]

First, thank you so much for your reply & insight!

WOW! In your 5th paragraph... talking about the cruise. I have actually had that thought too, but I really thought that maybe I was thinking too hard about it. We took a friend of hers with us. When the "episode" started her friend had gotten sea sick earlier in the day. So when my husband & I were going to get food we stopped by their cabin & asked if she would like us to bring her something back. By the time we brought the food back & went back to our cabin is when her friend came & knocked on our door crying saying our DD was screaming at her. My DD was yelling at her, saying she was taking advantage of us?! That's when it all started to go down hill. It's like she felt slighted by her friend, but it was really blown out of proportion & we certainly didn't mind bringing her food back to their cabin. We felt terrible that she wasn't feeling well actually.... that makes so much sense now. Thank you!!! I am taking your words to heart. I will definitely be her advocate & ally. Always. As much as she is willing to allow.

I picked her up today & saw the light back in her eyes. We got Chick-Fil-A & actually LAUGHED on the way home.  Laughed so hard we were crying

[CC43]

It's like she felt slighted by her friend, but it was really blown out of proportion & we certainly didn't mind bringing her food back to their cabin.

I'm not a psychologist, but that sounds a lot like BPD to me.  With my stepdaughter, there were some typical scenarios that seemed to trigger outbursts, and this particular one combines two of them!  First, holidays or vacations are very triggering times.  That may be because she sees other people happy, while she's not feeling happy in that moment, and she feels jealous and/or alienated.  Second, sickness can be triggering--if you read these boards, you can see that sickness is often mentioned as provoking some sort of meltdown, excessive neediness/demandingness or seemingly illogical reaction.  I think that might be because others appear to be getting attention, and she feels left out, bordering on "abandoned," which is a recognized BPD trigger.  She might go as far to accuse her friend of faking a sickness, to garner that parental attention which she feels she deserves 100% of the time.  Or she might feel that her friend is sabotaging her vacation, intentionally or not.  She might feel resentment, and that she's running a risk that she could fall ill, too.  All these feelings of abandonment, sabotage and not being the center of attention, if only temporarily, rile her up.  Her emotions are overpowering, crowding out her ability to take things in perspective (people get sick sometimes, her friend needs some rest, maybe she and her friend could take it easy today, etc.) or push past the minor inconvenience.  Instead, she boils over, and she might even project her own insecurities on the situation:  "You're such a narcissist, making everything about you, trying to ruin the vacation, you're a terrible friend, all you ever want to do is sleep all day, all you do is take advantage of my parents, you're so selfish."  Does that ring any bells?  If the accusations seem totally out of line, my hunch is that she's projecting what she feels about herself onto her friend.  The reason I know this is it's exactly the sort of thing my BPD stepdaughter would do when untreated.

Do you want to know what's bugging your daughter?  Listen for projections, and listen to the FEELINGS behind her outbursts, not the facts, because the facts are typically wildly distorted or out of proportion.  Does she feel demeaned, disrespected or slighted all the time?  Then I'd say she feels inferior, child-like and lacking in self confidence.  Does she feel that others are purposely trying to hurt her?  That I imagine is her own thoughts of harming others (likely in retribution for perceived wrongs), but projected onto the other person.  Alternatively, she might be projecting her thoughts about self-harm or suicide onto others, a manifestation of her wish that she could die and escape the pain she's experiencing.  Is she hurling insults that seem totally misplaced?  My hunch is that those insults might be what she thinks about herself, and they haunt her so much that they are always top of mind, ready to be unleashed in a rage directed at someone else.

[Pook075]

Hello and welcome to the family!  I'm so sorry you're going through this and even more sorry that you haven't received a diagnosis.  I'm not as sold on BPD but there are several boxes that are checked in your story.

About the pot usage- I don't smoke it and I am sternly against my BPD daughter using recreational drugs.  Yet when she's having a full blown panic attack over something trivial and can't calm down any other way, I can either try to take her to in-patient, or I can allow her to hang out with one one her friends for a bit, get high, then have a fairly pleasant evening.  So as much as I hate it, I no longer condone it either.

As far as a diagnosis, what are the in-house psychiatrists saying?  Has she been given a recommendation to follow up with an outside physician?  Does she seek therapy on a regular basis?

My daughter was unofficially diagnosed with bipolar at 15 and BPD at 16.  Part of that diagnosis requires them to be 18 though- it's an actual criteria to rule out teenage rebellion or ADD being mis-diagnosed.  Now at 26 her therapist has mentioned autism several times, which could fit some of what she's dealing with on a daily basis.  I'm sharing this to say that even when diagnosed, it's little more than a label.  The real work starts when your kid is ready to actually work towards change, and that could be years or decades away.

What are you personally doing to cope with the pressure and stress that's on you?  Have you considered therapy to receive an expert's guidance?