I have returned Anyone else have a child with borderline/traits AND bipolar?

[BioAdoptMom3]

I was here several years ago when all the pros thought now 17 y/o DD had BPD traits  . She was misdiagnosed with major depressive disorder at 11 and placed on Prozac which we now know was the worst thing she could have been on, then pdocs and a therapist were sure it was BPD rather than MDD. An excellent pdoc at an RTC when she was 14 diagnosed her with bipolar with paranoid features. Her quick and manic response to the Prozac was his first clue as well as what history we knew of the bios. Her bipolar symptoms now that she is nearing adulthood are classic so there are no doubts there. She does not have a good history of med compliance due mostly to the weight gain caused by Lithium and some of the anti-psychotics. She is now on Trileptal after refusing meds for 6 months and after a month her response is good though we know that will only work for the bipolar. We have the best pdoc she has ever seen who after several consultations has determined that we are dealing with both disorders. She sees a therapist weekly. I know there are no meds for BPD. Does anyone else have a child with both bipolar and BPD? Do you have any suggestions and/or advice?  We are also dealing with self-medication with cannabis and possibly of late, opiates. Any help anyone can offer would be so appreciated. DH and I have not talked with the pdoc in detail yet about the BPD and she has another appointment in mid March. In the meantime we feel pretty lost about what to do with her having both disorders, and a heck of a lot more hopeless.

Thanks!

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

[livednlearned]

Hi BioAdoptMom3,

That's great you have a good pdoc -- what a difference that can make!

My SO's D19 is diagnosed bipolar, and is on an anti-psychotic (can't remember which one... .Risperadal?) and something for her bipolar that causes weight gain (not Lithium). She came to live with us for the summer and she meets 8 out of 9 BPD criteria -- it was my T who mentioned BPD and everything makes so much sense. She is a subtype some refer to as internalizing depressive, or "quiet borderline," so it was a whole new aspect of BPD to learn about.

SO never saw mania in D19, and he has some doubts about the bipolar dx, but D19 clings to it somewhat defensively, and when he suggests she talk to a new psychiatrist or discuss changing meds, especially due to the weight gain that is fairly significant for how young and short she is, she gets extremely agitated.

She doesn't self-medicate with drugs like your D does, though when she visits I find I have to squirrel food away or else she will eat everything. I suspect she uses food to deal with her anxiety.

Two helpful books I read include Loving Someone with BPD by Shari Manning, and Overcoming BPD by Valerie Porr. They both have a lot of hands-on skills that I've been adding to my toolkit. The skill that works best with D19 is validating questions -- this allows me to validate her feelings and put responsibility for her behavior on her shoulders, and helps prevent me from falling into a rescue/fix role with her.

What does your D think about the BPD dx? Are the BPD traits she had at 15 the same ones she has now?

[Bright Day Mom]

My DD now 17 also suffers from both too!  It has been quite the ride to say the least, but I am happy to say she has come a long way this past year.

She is on a cocktail of Lithium, Seroquel XR, Remeron and Visteril for anxiety.  Its a lot, but she is finally able to function as a teen.  We are vigilant with meds, she attends a therapeutic HS, 1 day week meets with mentor, 1/week in home therapist and had completed an 8 month residential stay that ended in October. 

Things can get better; the tools to the right have been very useful, lots of validation and tons of empathy.  Communication as a family has changed significantly and we are all recovering, slow and steady.

You are not alone, lots of help is avail.

[BioAdoptMom3]

Thank you both for your replies, empathy and wisdom!  Our DD does experience symptoms of mania (little sleep and still has energy, hypersexuality, grandiosity (big time on both of those) and others. She also experiences depressive crashes, though when she was younger seemed to spend a lot more time in depression (explains the MDD diagnosis at 11 which was incorrect). I am not sure where to draw the line between the BP and BPD because so many of the symptoms are similar.

I am so glad to be back here among friends who get it!

[livednlearned]

That's helpful to know about the way mania presents in kids with bipolar. Is that the same thing as dysphoria? I'll have to check the book out that you mention.

I am not sure where to draw the line between the BP and BPD because so many of the symptoms are similar.

With D19, the skill we use with the most success is validation. It's a simple skill to learn but takes some experimentation and a lot of practice to do well. Validating how she feels helps us prevent making her emotional arousal worse, though it does not necessarily stop the mood swings, if that makes sense.

I no longer try to draw the line between the two disorders in D19. She has intense mood states, some are driven by her own biology, and some are based on reactivity to what is happening around her, especially the words and actions of loved ones.

All we can do is try to prevent things from getting worse, and we use validation skills for that. The tricky part of BPD is that she has no boundaries, no sense of self, cannot tolerate being alone, and suffers from cognitive distortions that are often negatively self-referential (like the aggression turned inward you mentioned). This part seems more about her personal belief system about herself than mood, although her unstable mood affect is partly why she struggles to see things clearly.

I notice that if she is dysregulated, she only remembers the negative emotion of the most emotional moment in the conversation, and that becomes her reality. We have to validate how she feels, and carefully introduce reality testing without making her feel like we doubt her interpretation of events. Not easy to do! Sometimes it's best to validate how she feels and then wait until she is regulated to revisit and iron out the misconceptions, especially if they are big ones. Sometimes they are swiftly replaced as though they never existed and we try to watch for that too. No point making a big deal over something that she has moved on from.

One thing, too, about both disorders. It's essential to take care of yourself. My T likes to say the disorders are explanations not excuses, and that is the mantra I repeat when I find myself getting steam rollered by D19's moods.

Even small things like her mania-like free association when she dominates the conversation and seems like she's speaking to an audience of 500 when it's just the two of us. I have learned I need to slow her roll, and that it's ok to say I'm having a hard time following the conversation, or that I want to hear what she's saying but the swearing and cursing is distracting me from the story.

In other words, love and care for her but not at the expense of my own values and boundaries.

[BioAdoptMom3]

You are so right about self care and boundaries for myself. I am guessing all of us parents are the same, but its so hard to let go and live our lives when there is nothing else left that we can do to help. I seem to constantly have thoughts running through my mind about what else I can do, what I should have done, what I definitely will do when she gets home... .its never ending. I have to break free from that!

[Robyn0718]

My 50 year old D has both BPD and bipolar disorder.  The BPD was evident by mid-to-late teens, the bipolar didn't manifest until a few years ago.  My understanding is that BPD is an issue of emotional dysregulation, whereas bipolar is a mood disorder, the important difference being that emotions are more transient (e.g., hours, etc.) whereas moods can last for days or weeks.  I'm not sure the distinction always holds, but it is useful for me to help understand what is going on with her. 

Her manic episodes last usually 2 or 3 days at least, during which she will not sleep at all and work feverishly at some task or project, going into excruciating detail; she is prescribed lithium - but I'm not sure how faithful she is about taking it - and also risperdal, which she will rarely take.  She has gained an enormous amount of weight, probably from the drugs.  She has had very poor pdoc care for the last several years due to lack of good providers where she lives - hopefully that is about to change, as she is (maybe) moving.

What is interesting (if that's the right word) is that when she's manic, the BPD hardly raises its head!  She is happy and content and interactive.  It is after the crash, the long sleeps and periods of depression that she becomes hypersensitive to anything that she perceives as criticism (which is virtually everything!).

I'm not sure any of this will be helpful, but i wanted to reach out and let you know that there are other people who live in this situation and know how difficult it can be.  Frankly, i find the bipolar episodes to be MUCH less difficult to handle than the BPD episodes.  Bipolar can be medically managed, although it may take a while to find the right meds; once you do, it really presents very few problems.  So, perhaps at the least, life will not get *more* difficult now that you have identified this part of the problem!