Handling uBPD sister's death/suicidal talk?

[R2D2]

My sister is not diagnosed but presents with many key traits of BPD. We live 3 hours apart and so communicate by Facebook Messenger pretty much all day every day. I've spent the last 6 months working hard on my own codependency with her - when she sounds depressed or complains I feel like I must fix it because otherwise I will be worried about her.

One recurring problem I have is knowing how to respond when she says things like "I'm gonna die" or "Life is too hard for me." She's a grad student, she is diagnosed with depression and taking meds, but she also has a tendency to say things like this offhand, and when it's over text I can't tell what's really going on. Today I finally said, "Do you need to talk to someone, like call a hotline? I'm getting scared." That's the first time I have EVER expressed to her how her talk makes me feel. She said no, it's not as bad as it's been before, and it's situational around an exam she has to take today (hating herself for not studying better, the usual).

Most of the time, when she talks like that, I either ignore it or try to encourage her, but it always sends me on a codependent tailspin. It was helpful today to be more direct about it for once, but I don't really know what the "right" thing to do is in these situations. Like I said, I can't tell the context of her words because it's all text based, and she can be pretty flippant with her language, but my fear response is always real.

She doesn't go to therapy anymore (decided her therapist, and therefore all therapists, is bad). She is moving away from most of the support structures she grew up in, particularly church (has decided all church is bad). She has friends at grad school, which has helped her function better in the last few terms, but myself and my mom still seem to be the crutches she really leans on when she's distraught, and we are feeling the effects of it. How do I set boundaries without feeling like it's my fault if she harms herself? Is there any way I can encourage her to get help or support when she's decided all therapy and church is horrible? She just doesn't seem interested in helping herself anymore.

[Kwamina]

Hi R2D2

It's difficult indeed to handle loved ones who suffer from suicidal ideation. Your sister is still taking her meds but unfortunately has stopped therapy. How long ago was she diagnosed with depression?

I understand your fear and anxiety when your sister says things like this. If she indeed suffers from suicidal ideation, this is something for trained professionals to help her with. Has suicidal ideation been something she has struggled with for longer or only since she entered grad school?

We have a thread here that you might find helpful about handling suicidal ideation in others:
Handling suicidal ideation in others

The thread contains practical tips for how to respond to threats of suicide and accounts from members sharing their own experiences and advice.

The Board Parrot

PS. Glad to see you join us from a galaxy far far away

[R2D2]

Thanks for your reply. My sister was diagnosed with depression a year ago, but it has definitely been going on longer than that - probably 5-7 years at least. She just never went to a doctor or therapist until last year. I don't know how long suicidal ideation was part of it; I know that the most severe time was the middle of last school year (winter term) but she has some history of self-harm before that so I would guess it's gone on longer than any of us knows.

I will check out that thread. Do you think there's a way to encourage her to return to professional help after she's decided it's all bad? Can a pwBPD be persuaded once their mind is made up? I have brought it up a few times, as carefully and non-pushy as I can, and she has not outright rejected the idea but she also hasn't taken any action on it.

[Harri]

Hi R2D2.

I am not sure how to get someone into therapy or even to go to a doctor if they don't want to.  You are in a very difficult situation to say the least.

Generally, we recommend saying something along the lines of:  "I care about you and I want to help and support you.  I am not trained or qualified to help you with this though.  Do you want me to drive you to the emergency room or call an ambulance?"  Or, since you live 3 hours away, "Do you want to call a friend to take you to the hospital or do you want me to call the ambulance from here?"

State this as an either or option.  Don't leave it open ended.

Is she unwilling to even see her PCP who can help her with an anti-depressant?   I am wondering if a variation of what I wrote above would help when she is talking about not wanting to go to see a doctor.  Something along the lines of:  "I really care about you and I want to help you so lets set up an appointment for you to see your PCP (or a therapist)" and then do it together. 

Thoughts?

[R2D2]

She already takes an anti depressant, which has definitely helped but there are still pretty significant mood swings. I'm not sure if going to her PCP would really make a difference. What she really needs is to get back into therapy but like you said, it's really hard to know how to encourage that when she doesn't want to.

I will take your suggestions for what to say when she is really bad though.

[Harri]

R2D2, you can also try calling the suicide hotline and explain the situation to them and see if they can recommend anything.  It will help you too as this is 'too much' for one person to deal with.

I wish I had a better answer for you though. 

[Kwamina]

Hi again R2D2

Do you think there's a way to encourage her to return to professional help after she's decided it's all bad? Can a pwBPD be persuaded once their mind is made up? I have brought it up a few times, as carefully and non-pushy as I can, and she has not outright rejected the idea but she also hasn't taken any action on it.

I think it's very difficult to get people to change if they don't want to themselves. That's an unfortunate reality when dealing with disordered family-members.

Do you feel like your sister has ever truly acknowledged the severity of her issues and how her behavior also impacts others?

What we can strive to control is our own behavior and how we respond to our disordered family-members. Using the tips from that thread I shared with you, Harri's response suggestions, and also utilizing the communication techniques described on this site such as Validation and S.E.T. (Support, Empathy, Truth), can help you in your interactions with your sister.