BPD causing delusional behaviour

[GlobeTrotterGirl]

Hi All

I'm 46 and my 74 year old mother has been a difficult person all my life and I realised after my dad 9 years ago that she ticks every box for BPD and myself, my aunt and my brother are in no doubt that she has it - not that we could tell her that! Age has currently gone in to another episode and is now driving my brother and aunt away, she's giving them the suicide talk but also treating them.lihw they've done something wrong but won't tell them what, she kept telling my brother on Sunday that he can't be trusted and was mean to him.avd this came on after months of winter getting her down. She claims to have stockpiles pills, she made a strange claim that a woman who works in a store in her town will.yaie the dog after she's taken her own life - the paranoid and suspicion seem really to point of being delusional behaviour! I've long since thought that she gets fantasies in her head which she believes are real as to what she perceives people have done.

Has anyone else experienced a relative with BPD becoming completely delusional? I did try and get her doctors to take seriously that she likely has BPD once but they didn't want to know! It's so hard to know what to do! She's very cruel when she's like this abs she is of course widowed and  living aline in these delusional states!

Thing is she is like egg shells too, she thinks we don't speak to each other about her and sees it as cardinal sin to do so and would go beserk if she knew that we confide in and support each other through it! It's like BPD people forget what family means! My brother is 51 and just getting sorted with a very overdue ADHD diagnosis and meds so it's not fair what she puts him through, my aunt lost her husband suddenly and prematurely just a year after my dad died but my mum doesn't seem to care about that. It's all about her really bad it's frustrating as I know it's the illness but we seem to be stuck with forever dealing with jit. She has driven most other extended family away or refuses to have anything to do with them - again it's always perceiving in her own head that they've done something!
 

[Notwendy]

Has anyone else experienced a relative with BPD becoming completely delusional?

Yes, with my (now deceased) BPD mother, and while this kind of thinking was there all along, I think in an elderly person, other causes can exacerbate them and even cause them without BPD.

Two common causes of delirium in elderly people are urinary infections and medications. There were times when the diagnosis of dementia was considered but BPD mother would return to baseline when she was treated for  a UTI or her medication dose adjusted. If your mother is acting more delusional than usual, I would say get her checked for these possible causes.

The more constant concern was the BPD thinking which included these strange and sometimes paranoid ideas about people, and her behavior in general. Being that she remained "legally competent" there wasn't much family could do to intervene on her behalf, even thought it was for her own benefit.

I understand your concern for your elderly widowed mother at home with her BPD. We had this concern as well.

It helps to inform yourself of the resources for the elderly in your country. For me, it's the US- and so learning about Medicare, Medicaid, assisted living, skilled nursing homes- and the laws, and rules for these resources helped to know what was (and wasn't) available to help if needed. As long as my mother remained legally competent (and she did, even with the episodes) intervention wasn't possible.

My best advice to you in this situation is to have someone designated as POA and Medial POA for your mother so it would be possible to make decisions for her if needed. It can be you or another family member if they are trustworthy and would act in her best interest. Also inform yourself of resources available to her- assistance at home, assisted living, nursing home care- if they were ever to be needed. Most important- get support for yourself through counseling, maintain self care.

With the medical POA, I was able to speak to her doctors and health care providers. In BPD mother's situation, "BPD" was not a helpful label.  It made more sense to address the issues that were a cause of discomfort for her- her anxiety was a main one and there is medicine for that. Your mother can access therapy and medication without the BPD label - with other ones such as "anxiety". DBT therapy is known to help with BPD and she may need the label for that but she would need to be motivated to do it.

[CC43]

Hi there,

Notwendy gives awesome advice, she's wise and has a lifetime of experience with this.

I'd underline the notion that delusions can be a "manifestation" of extra stress, whether mental or physical.

With the elderly, any sort of "odd" behavior can signal a seemingly unrelated problem--like dehydration, not taking medications at the normal times, dieting/not eating right, an infection, bout with illness.  I agree with Notwendy that it's probably a good idea to have a doctor check her out.  I recently went through a situation with an elderly relative who had lost some weight from intensive dieting, and her medications became too potent, leading to some uncharacteristicly loopy behaviors.  This happened after a string of other questionable choices she had been making regarding her routines in the last couple of years.  Since she's elderly, her "missteps" are now having more serious consequences, as she's increasingly frail.  Her children have had to keep a even closer eye on her.  Maybe you are approaching that inflection point with your mother.  It might be a good time to put in place some extra help and resources.

I'm often asking myself if my elderly mom is still OK to take care of herself.  I think she is, but you see, she's a lefty and has always had trouble with navigation and spacial awareness, which in real life looks like confusion and very slow driving.  Now I know that's not BPD--I'm just trying to illustrate that I understand how it can be difficult sometimes to interpret if "odd" behavior is because of an innate condition (i.e. lefthandedness/spacial reasoning difficulties or BPD), or if it's potentially something else (a medical problem, advancing aging).  I try to guide myself using the "severity" of incidents as well as the "frequency" of behaviors and how much they veer from the "normal" baseline.  An example might be, if my mom forgot where she parked the car, that would be pretty normal for her, and it's not life-threatening, either.  But if my husband forgot where he parked the car, I'd start to be concerned, because he's uber-protective of his car and has a great sense of direction.

But you know your mom best, if you are concerned and you're worried about her, I'd say don't be afraid to have her checked out.

[Notwendy]

Thanks CC43. I forgot to mention dehydration. Dehydration and urinary infections are common causes of mental status changes in elderly people and were for my BPD mother as well. I think getting your mother checked would be the first thing to do. (hopefully she is willing to do that).

Also medication- any medication and how an elderly person reacts to medicine can change. My BPD mother was on a medicine for anxiety that worked well for her. Then, the same dose she was taking was too much and also caused her to be (more) dellusional. She needed a lower dose. Also over the counter medicines- those had to be checked too.

It's challeging to have the "normal" events in an elderly person and BPD combined as it's hard to know what is what, but I'd err on the side of checking for things like dehydration, medicine, infection- since they are treatable.

[GlobeTrotterGirl]

Hi Both, thank you for taking the time to reply to me, my brother went to her home again yesterday expecting a war with her after she was paranoid about him on Sunday but she was nice as pie!  She still has it in for my aunt though. It can change on a sixpence as to who she is angry with! The problem we have is that she is generally good physically and mentally for her age and would go beserk at the suggestion of extra care or POAs. The additional issue that we have either her is that for many decades the medical profession have just treated her mental health issues as something that needs Diazepams and Lorazepams and essentially they created an addict! She can't function without these tablets and she does claim to overuse them if she's gone into a bad place. So whether they impact this distorted thinking that she gets about people and the things her head tells her they've done.
It's like another obsession she has at the minute is she is always trying to invent a dramatic life story for herself and keeps trying to claim that one of her parents wasn't her parent but we both did ancestry DNA tests and it was bang on the button that my grandparents are my genuine grandparents and her parents! Yet she is ignoring that.
I think we'll be destined to be putting up with her moods and thoughts that change at the flick of the switch until she eventually dies  I think! She doesn't want to help herself or be helped - I get that winter months are dismal and hard on her but her refusal to go out and to anything, get involved in anything or socialise isn't helping her. The other hard thing of course is the frequent suicide threats when she is unhappy and not knowing she'll eventually do it!

[Notwendy]

It was a challenge with my BPD mother too. She was resistant to therapy or even the consideration that she had BPD. She had also been treated with prescription medicines and was dependent on them-not only physically.  At one point, her doctor took her off them. Her anxiety and emotional distress were extreme. She got back on them.

I understand being powerless. It's natural to be concerned for your widowed elderly mother, and yet, not be able to do anything to help the situation. We kids were concerned about my BPD mother after my father passed away. She had been so dependent on him. Suicide threats were a concern too. However, we didn't live with her, we had our own families and jobs. We could not watch her all the time. So we decided if we had any concerns, if she made a threat, we'd call 911 emergency. That's the best anyone can do.

BPD mother also didn't allow us to have any imput or information about her finances or medical records. After Dad passed away, she redid her legal papers, wrote someone else in as POA. We had no idea how she was managing.

What we realized is that- we could not be proactive with her. She was doing well physically. As far as we knew, she had sufficient funds for her needs, but we didn't know any information about that. As long as she was legally competent, we could not do anything, even if we were concerned.

What I noticed with the delusional thinking was that, if there was something going on with her medically- the quality of it would change, but also stress could do that too. It was not possible to tell what was actually going on. There were the usual wild statements- her baseline- like saying a relative was on drugs (she wasn't) and saying someone was being abusive to her when they weren't. These were not without consequences as it did push people away but there's no controlling this. But sometimes she'd act as if she was confused, didn't know where she was, thinking she was somewhere else- and these times were when it was medicine or an infection, or dehydration.

Still, there was no way to control this, or intervene proactively. It could only be done in a crisis situation. It's also difficult for you due to expectations. People wonder why an elderly person is "left" to fend for themselves - where are the adult children. Also for the adult children who are concerned but have no ability to intervene, as well as who also need boundaries on abusive behavior.

Around this time, I also saw what "normal" is. My inlaws were getting older. They sat down with their adult kids, gave them all the information needed, expressed their wishes, made them POA. They had their moments too-of frustration, anger, the "normal" for this situation. With BPD- there may be similar circumstances but with BPD influencing the behavior.

This is an emotional situation. It's important for you to take care of your own emotional well being. Prepare yourself for what to do if needed. I did consult an elder law attorney and social services to learn the rules, and resources. It helped to know what they were, even if I couldn't do anything.

How much we could be involved was determined by BPD mother. At one point, she rewrote her legal papers, made her kids POA. But even with the POA, BPD mother remained self directed, and made her own decisions.

If your mother won't establish someone as POA, there may be a point where someone has to legally step in. It can be you, or someone else. Being POA is voluntary.

Without any ability to be proactive, have a cooperative relationship, all we could do was keep a watch on her, determine what we were willing to do if needed and if she allowed us to.

[CC43]

It's like another obsession she has at the minute is she is always trying to invent a dramatic life story for herself and keeps trying to claim that one of her parents wasn't her parent but we both did ancestry DNA tests and it was bang on the button that my grandparents are my genuine grandparents and her parents! Yet she is ignoring that.

Hi there,

Inventing a dramatic life story sounds like typical BPD to me.  It could be a bid for attention--YOUR attention--typically of the sympathic-pity sort.  In addition, your mom might crave drama, as she finds it stimulating, and she gets a reaction out of others.  She might be trying to develop a victim narrative--My real parent abandoned me, it's so unfair, poor me, no wonder I'm such a mess, it's THEIR FAULT!  But my guess is that saying her parent isn't her "real" parent is code for, "I never really bonded with my parent and I'm upset about that."  Is she talking about her mom?  Not bonding with the same-sex parent can feel especially traumatic.

I think my natural inclination in this situation would be to ignore the whole narrative.  But sometimes validation is recommended.  You might say something like, It would be disconcerting to feel your parent wasn't there for you, and then see where it goes.  If you're feeling charitable you might say, Well I'm glad you're my mom and I love you.

On another note, I have an elderly relative in my life who is a "dreamer" sort.  Since I lie on the opposite end of the spectrum (I'm a doer and more logical/less emotional thinker), I found myself being bothered by her "fantasies."  An example is when she'd talk about getting married again--in her mid-80s after being single for the last 50 years.  She talked about a wedding, honeymoon, etc. when she barely leaves her house, let alone date anyone.  It just sounds completely DELUSIONAL.  I found it was best for me not to engage in this sort of talk, because it would make me upset, talking about fantasies like that.  But she's going to do it anyway, because I think she likes living in a dream world.  Since I don't, I try to refrain from egging her on when I'm with her.

[Notwendy]

I agree that the drama and even some of the crisis were attention seeking but for a reason we were not fully aware of. Dad had been a significant emotional caretaker for her. When he got ill, his ability to do this changed and also the situation was understably stressful for BPD mother. Her BPD behavior escalated. It was verbally and emotionally abusive. I had to have boundaries with this.

For a person with BPD, admitting that they have any issues causes them shame. If BPD mother wanted something, the reason she would give for that wasn't usually the reason. Rather than to ask for attention, she'd come up with drama. It worked for her as it brought attention to her. However, ignoring the drama also didn't meet her emotional needs either.

BPD mother was angry at me at the time my father passed away and didn't have much interest in contact with me for a time. She kept her public persona up with other people. I kept contact with her and other people would tell me she seemed to be doing fine. In reality, she wasn't. She was OK physically. Emotionally, she was not. But I had no way of knowing.

Eventually, during a visit, we discovered by accident that she had taken out a home equity loan a while back, didn't tell us, and also had spent a lot of it. Realizing she had to have done this due to running out of money, we asked for information but she refused. Later, when relatives became concerned, it was apparent that she was not managing on her own. She had to move to assisted living- but it was her relatives who were able to convince her, not us kids.

Eventually I was able to participate in discussions with her health care providers, as I had a POA. BPD affects the closest relationships the most, so ironically, BPD mother would accept advice from other people better than she would with me.

But what I did learn about BPD mother is that she could not handle being alone. When she was alone, her anxiety would be overwhelming. Not wanting to admit this, she'd cause drama instead, and people would attend to her. I also realized that in her own way, she did want a relationship with me, but due to her BPD, she couldn't have a relationship without drama and the closer one is to her, the more her behaviors are involved. For her, drama was the relationship but I felt the need to have boundaries with the drama.

I think adult children of a disordered mother are in a different situation. We want a relationship with our mothers- a normal one, but it's not ever been normal and it can't be. My mother's elder years were just another version of this wish. My peers were helping with their elderly mothers. Even if there were challenges- due to dementia, or changes in personality- the bond was there, formed over many years. Also, it was reciprocal. It wasn't like this with BPD mother.

The stage of having elderly parents is a challenge,  but I think it's one that adult children still can manage in a "normal" situation. Dealing with BPD is different. Your mother may be stirring up drama because, now she's on her own, she wants the interaction with people but doesn't have the skills to get this in the "normal" way. Do the best you can while also preserving your own emotional well being, your own family, your job and other responsibilties.

[GlobeTrotterGirl]

You are all absolutely nailing the way my mother is, it's like we all have the same mother! My mother didn't bond with her parents that well especially her mother but her mother had every BPD trait too and was not a great mother. My mum harbours this weird jealousy about my aunt who is her younger sister, it's like shes the older sibling that still has that very childlike jealousy that my aunt was born and took attention away from my mum.
My mum in recent years tries to invent things that she claims my grandad did when she was child such as sexual abuse, beating her up and leaving her locked in her room for days - she lived in a household of 8 people! My great grandparents were under the same roof and three other siblings and this was never seen to happen. My poor grandad in all reality dealt with an awful lot due to my grans probable BPD!

I'm feeling annoyed with the NHS here in the UK because I read today that benzodiazepines make BPD worse! So have we had to sustain 40 odd years of abuse and childhood violence because not only did they misdiagnose her but got her addicted to something that makes it worse!

[Notwendy]

It's understandable to blame the benzodiazepines and a possible missed diagnosis, but the diagnosis of BPD can be very hard to obtain and even not possible. There's no medical test for it. A therapist can only know what the pwBPD is telling them. They may not tell the whole story in therapy. From what I have heard, my BPD mother did not.

Also, there's no medication specifically for BPD. The recommendation for DBT therapy is relatively new compared to the older medications. For DBT to be effective, the pwBPD needs to accept the diagnosis and be willing to be open with the therapist about their issues. My mother could not do either.

There's also the history of the use of addictive medicines. Probably only in the last 20 years was there action to diminish the use of them, once there became an addiction epidemic for some of them, mainly opioids. There's an old Rolling Stones song "Mother's Little Helper" - released in 1966 about Valium- which was being given out to housewives at the time as a way to release their stress. It was so common that this song became a hit song- as so many people knew what they were singing about.

It's not that the NHS did anything "wrong" with what they knew to do at the time. This is what they thought was the right thing to do at the time for the symptoms your mother probably came to them for.

Addiction is complicated. There's the physical aspect and then, the emotional aspect- what drives someone to become addicted. All addictions are a way to escape emotional pain. I do believe that if it wasn't benzodiazepines, it would have been something else. For BPD mother, it was alcohol at first- that also reduced her inhibition and led to rages. Then- like so many women in her era- and probably for your mother some time later- she got benzodiazepines

In recent times, now that there's more awareness of the addictive nature of drugs like opioids, and benzodiazepines, there's been an effort to reduce prescribing them and also to regulate them. At one point, my mother's doctor sent her to rehab to get her off them. Although she was not physically dependent on them for a while after that time, emotionally, she could not cope at all. She was miserable. Her anxiety was overwhelming, her emotional distress- which was caused by her BPD- was extreme.

It became a quality of life decision. She did not follow through with the therapy recommendations. She was emotionally struggling. She restarted medicine with the supervision of a psychiatrist. There are better medicines for anxiety now but even those didn't take it down enough. She did better when a benzodiazepine was added.

There's the ideal- if your mother could get off her medicines, and do DBT- that would be the recommendation now. But now, you have a woman in her 70's who has not had DBT or learned other coping skills, and if she's not willing to do that now, the less ideal choice may still be the one that fits her.

I understand the anger at it though. I felt that too. I felt that if only BPD mother would stop drinking, or stop the medicines, she'd be a lot better. But when I saw her off everything, and saw the extent of her emotional distress, I could see it was worse for her. 

[GlobeTrotterGirl]

Mental health help is a mess in my country, they've been dealing with her for decades and even given her electrode therapy when I was a kid. She had a crisis care team after my dad died and she spiralled but because she's always difficult and won't agree to get involved in volunteering etc, they would just stop bothering with her after a handful of sessions and then she'd be left to her own devices again.
Her doctors surgery is literally across from her house and they just seem to pally with her to actually see whats really going on! They know she gets suicidal as she went in there crying that she was suicidal once, during COVID she had to leave messages on their answerphone to get her Lorazepam prescribed and my mum realised that she could get away with ordering prescriptions more often than she was supposed to! She would use different chemists so she didn't realise suspicion and she went through a phase of over using Lorazepams and washing them down with wine! I had to contact her surgery and ask them to watch what they were prescribing because they were unknowingly over prescribing to her! My mum then became puzzled when she suddenly couldn't get as many prescriptions anymore! I told them about BPD then and they've done nothing in the years since. I live 36 miles from her, she pushes my brother away who also often works away, I've said to the doctors before that we can't watch what she does or safeguard her! She could carry out her threat to take the pills she's claimed she's stockpiled at anytime after be lying dead. The NHS don't help us and have actually refused to even speak to us as her family about her mental health even when the police and ambulance had to go to her home because she put a suicide note through my brothers door one time! They were reluctant to even tell me if she was sectioned or still at her home, they didn't section her even though at that point she told them that she was going to give herself and her dog and overdose on her pills! It's crazy!

[Notwendy]

This is similar to my BPD mother- she had mental health- they couldn't do much for her. Like you, I also tried to speak to one of her mental health doctors but he refused to speak with me, due to pricacy laws.

Before the medicines were registed on computer and regulated, my BPD mother also would get them from several doctors, none of them knowing about each other. I told her general practice doctor about it, but he wasn't able to say much to me about it due to privacy laws at the time.

Some time later, once the medicines were regulated, he was able to see what was going on and that is when he put her in rehab. She was uncooperative there and signed herself out AMA. (against medical advice).

Here, in the US, it seems our mental health system is lacking in ways and so is the care for the elderly. Like your mother, my mother did not have a lot of physical needs but her emotional needs were very high. In addition, she could "pull herself together" when being evaluated and appear completely normal to providers and so she remained legally competent.

If someone is legally competent, health care providers are limited in what they can do for them if the patient doesn't choose to cooperate with them. Also, if a patient is not compliant with the care plan- the providers can choose to not treat them, and also insurance won't cover it. Before I had the POA, I wasn't in contact with my mother's providers but in her later years, I was- and so could see this side of things. BPD mother's behavior was a challenge to her heath care providers, but with her being legally competent, their ability to help her in this situation was limited.

Even with suicide threats, they can not hold a person against their will for long if that person is legally competent and appears intact and not suicidal when they evaluate them.

I wish I had helpful advice for you in terms of a positive change for your mother, but the reality for me was that, as much as I wished there was some way to help my mother, change things for us as a family- there wasn't anything that could change her own self will. She was going to make her own choices. We didn't want her to harm herself but it wasn't possible to watch her all the time, or have her in a situation where she was watched all the time. We cared about her well being- as you care for your mother's too. But that didn't stop my mother from her own choices.

My best advice for you is to focus on your own well being in this. It's a difficult situation. I did counseling and 12 step ACA groups. These were very helpful. I think as adult children- in our family systems, we feel responsible for our BPD mothers' feelings and well being, but in actuality, we don't have that much control.

I don't suggest being detached from your mother all together. I didn't want that and it would have been impossible to not have feelings about her situation. I wish there was some resource to help her but even if there was- she'd have to choose it and cooperate with it. Even in "normal" situations, the advice to family members who have a part in care for an elderly parent- whether it's direct or indirect- is self care to avoid burn out. Taking care of yourself and having "time out" is helpful.