13 Year Old Daughter has gotten worse with normal treatment for OCD/MDD

[jjss]

Our 13 year old daughter has been completely normal up until 5 months ago.  Then she started worrying about school and started talking about feeling suicidal.  My sense from her is that the attention she received from teachers and counselors around the SI gave her the most amazing feeling that she's ever felt.  And it also helped her to get accommodations at school - and ultimately get out of school.  And that feeling is what she's been trying to get ever since.   

She's been to 2 PHP's and both times she started acquiring symptoms from the other kids in the program.  The last PHP (for OCD) she was in for 3 days and reported that her depression was gone.  But over the weekend after PHP started she created a suicidal plan with time/date, acquired the method (drinking cleaning solution), and wrote a suicide note.  She talked to a friend about this and that's how we ended up finding out about it. 

So the PHP said they could no longer deal with her and so residential was the only option.  So she is now in residential treatment for depression/ocd.

What we seem to be learning is that what she has been getting treatment for (depression/OCD) is not working because she's not being treated for what she actually has.  Those symptoms (depression/OCD)  just seem to have been acquired from others.  And those symptoms are what has allowed her to get what she's really looking for - which is feeling seen and being soothed. 

So, she's been in residential treatment for almost 3 weeks and it's paradise for her.  She gets to go out to Culvers, go to the bookstore, go on long walks with staff where she gets attention.  She's already talked to us about not wanting to come home because it's so great to be there.  And she's not really up for learning skills.  She's getting what she wants, so I completely understand why she wouldn't want to work on skills.  I can't imagine a world where she comes home and doesn't figure out how to go back to residential treatment within 1-2 weeks.  She's the kid of 2 therapists - so she's really proficient at knowing what to say to get her back into residential. 

Here are some questions:
1.  Have others been through this?  Of normal treatment causing the Suicidal behaviors to escalate? 
2.  We are thinking of moving her to a DBT residential program - which we hope would help to motivate her to learn skills for dealing with anxiety and obsessive thoughts.  Any thoughts on this?  The nice thing (theoretically) about DBT is that SI doesn't trump everything and wouldn't be reinforced in the same way as it is in the current program (and at at school)
3.  Anyone have experience with specific DBT residential programs?  I've found 2 I think might work - Nashotah Center (through Rogers Behavioral Health) and 3East DBT Program (through Mclean). 
4.  Any other advice? 

Thanks for any help you all can provide.

Non-critical information:
1.  Due to the sudden onset of these behaviors we have gone through an extensive process of ruling out almost all physical health causes of the behaviors.  The only 2 left are Cushings (which initial tests seem to eliminate) and PANDAS (she had a strep test and it was negative). 
2.  She was born at 24 weeks (1 lb 5 oz) and spent 100 days in the NICU.  She met all of the normal milestones (with slight delays). 
3.  She did have 3 surgeries from 18 mo. - 2.5 years to deal with kidney stones likely caused by the caffeine and other drugs doctors used to help her survive.  The whole process was quite traumatic for her.  She did 2 rounds of trauma therapy to deal with this (at age 11 and 12).  Therapy seemed to help. 

When I was trying to figure out how things have gotten so bad and continue getting worse - here are the 4 foundational problems we're struggling with:

1.  Being suicidal and sick works well to get her number 1 motivator - others caring and soothing her. Suicidal behavior works well to facilitate avoidance (school being difficult).  It’s working for her. 

2.  She’s not being treated for her accurate diagnosis.  The people helping are well intentioned but are treating her for conditions she does not have (e.g. depression, OCD). 

3.  Suicidal behaviors bypass normal limits and get results.  Suicidal behaviors get an incredibly powerful response from people and programs.  For instance, they put limits on her ability to attend programs and precludes her from dealing with the underlying problems by prioritizing dealing with suicidal behavior.     

4.  There are very few consequences to her behavior.  Most of those consequences are positive.  She experiences very little aversion around her behavior. 

Thanks again you all.
 
 

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

[Pook075]

Hello and welcome to the family.  I can completely relate with your journey and my BPD/bi-polar daughter was in that exact scenario approximately 13 years ago (she's almost 27 now).

First off, yes, the in-house treatment programs for teens is like going to a sleepaway camp.  That drove me nuts as well, and my kid would come home with all new best friends (who would eventually lead her to her next spiral as the others became suicidal).  She would steal cars to drive across the state to save others, she would run away from home, the list of behaviors were endless.

My kid was also super smart, low genius IQ.  In 7th grade, she scored in the top .1% nationwide in math for the standardized testing.  It was the highest score ever in our state, yet she got a "D" in math that year.  She deserved an "F" but they had pity on her because that's when all the in-house stuff started.

For the "this is the best place ever!!!" comments...that's only a partial truth.  Your kid is learning manipulation and she'd never tell you that she doesn't want to be there.  Why?  Because she can't let you win!  Those places are really nice though and it's necessary by law and to build rapport with the specialists.

Additionally, what's actually wrong...they don't diagnose most mental illnesses in the US for kids under 18.  That's because once it's on a chart, it never goes away, and a lot of it is juvenile rebellion.  Still, the longer she's in places like that, the sooner you'll get an unofficial diagnosis.  So it's a game you must play.

For my BPD daughter, the pattern was that she'd get down, be institutionalized, and meet others in the same boat as her.  They'd bond over commonality and develop super-deep connections, and the mirroring was also common.  Once something happened to one though, the others would go into crisis mode right alongside them because they'd have to "save each other".  But then they'd backstab one another and that's another round of treatment needed as they reeled from the betrayal.

The in-house facilities for teens are horrible...yet they're your best option by a longshot.  The only other path is finding a local therapist your kid really connects with.

Again, I'm so sorry to hear someone else is going through what I went through...I wouldn't wish it on anyone.  You have to play the game though because there's no other option.

[CC43]

Hi there,

I don't have experience with mental illness in someone so young.  I'll just share my lived experience to see if it rings any bells for you.

First off, I think BPD has elements of OCD and depression mixed in it.  The OCD part relates to intrusive negative thinking patterns.  The young adult pwBPD in my life will ruminate about issues so much that she can't focus on anything else.  I think that by replaying unpleasant incidents in her mind, she reinforces certain neural pathways, basically carving a rut in her brain!  The habitual rumination becomes oddly comforting to her, though in a mal-adaptive way.  Let's say she got into trouble at school.  This is so disturbing and shameful for her that she seeks to blame someone else.  In her mind, she calls up her favorite target of blame, her family.  She'll dredge up ancient altercations and perceived traumas as a distraction from her current problems, as well as to shift blame.  Basically she thinks, her family was abusive, they're the ones responsible for messing up her life, and that's the reason for all her problems at school.  The more she thinks about it, the more riled up she gets, and the more dysfunctional, too.  Another mind trick is to replay a neutral incident in her mind, but to distort the details to make herself out to be a victim of some sort of abuse or transgression.  I think a victim mindset is a hallmark of BPD and the associated obsessive thinking patterns.  It's an obsession, because she just can't seem to get past her negative feelings, and she'll twist her thinking to suit her victim narrative.

Then there's the depression aspect to BPD.  When pwBPD aren't busy hating others, they turn their hate inwards.  I see this as mainly an energy downshift, going from actively hating other people to becoming more passive and hating one's own existence entirely.  Deep down she knows she messed up, and she feels shame.  She can't see a way forward, any future for herself.  She loses all hope.  She feels exhausted, empty, sad and/or numb.  You see, with BPD, her emotional skills are lagging.  She lacks resilience, perspective, context, grit, self-compassion, patience.  She can't muster the resources to tolerate distress or delay gratification.  She has no energy to overcome obstacles.  Her mind is spent, she can't focus, let alone problem-solve.  She sees everything as black or white, but overwhelmingly black.  She does nothing and eventually feels like nothing.  It's easiest just to give up. 

You mention an aspect of contagion in your post.  I think there definitely can be an element of contagion.  It happened in my family.  My eldest stepdaughter attempted suicide in the fall of her sophomore year in college.  She withdrew and had a year off from school, which was basically treated like a very long vacation.  What happened to the second stepdaughter?  She also attempted suicide in the fall of her sophomore year in college, mere days away from the anniversary of her sister's suicide attempt.  Though of course there were differences between the girls, I can't help but see the "contagion" aspect.  It's almost as if the second stepdaughter felt that she DESERVED a year of vacation, since that's what her older sister got.  She knew exactly what she had to do to get that "vacation," which was to make a suicide attempt.  The timing was unsurprising to me--the beginning of sophomore year.  The novelty had worn off of the first year of college, and the support for incoming students had ceased.  The back-to-campus parties were over.  The classwork started getting harder.  The friend groups were more solidified, and hard to break into.  And both my stepdaughters were drama queens/self-centered/extremely moody, which got them kicked out of rooming groups, at exactly the same time in their college careers.  You see, BPD and BPD-like behaviors were enabled at the home front, and the girls grew up thinking it was OK to throw tantrums to get their way.  "Normal" people tire of that behavior very quickly.  So the girls were evicted, basically abandoned by their friends.  If you read these boards, fear of abandonment is a central issue for pwBPD.  So is impulsivity, over-the-top emotions, and catastrophic thinking--hence the first suicide attempt.

Finally, you mention the perverse incentives when it comes to treating mental illness.  In my family, dysfunctional behavior seems to be rewarded, with the ability to drop out of school/work/normal life and live as if one is on vacation at a resort.  Like you said, she's showered with attention from professionals and family alike, maybe even friends.  She convinces herself and the world that she's the "poor little traumatized girl"; it becomes her entire identity.  Her responsibilities disappear.  Expectations are re-calibrated, and she gets all sorts of concessions, in the name of keeping her safe and stable.  If the family isn't careful, tantrums and threats of violence are REWARDED, especially if parents are operating in a FOG of fear, obligation and guilt.  You see, pwBPD are masters at pushing buttons--the fear button, the hope button, the ATM button, the exhaustion button.  They might not be intentionally manipulative, but if you look at the results obtained, it's hard not to feel manipulated!  And these days, it seems that trauma and dysfunction are glorified in social media.  With all these perverse incentives, it's almost no wonder to me that an attention-craving young woman might feel compelled to indulge in unhealthy mental habits and behaviors.  I use the word "indulgence" because I do think there's an element of choice.  I know that might sound callous or jaded, but in my own experience, I think that pwBPD have more control of their behavior than they let on, because when the incentives for acting out are taken away, they seem to be able to reel it in.