How do I tell me daughter she has BPD

[fortwashington]

   I just learned that my daughter is suffering from BPD. She is 36, married, with two boys aged 5 and 9. It's highly likely that she's had this disorder for over 20 years.  But she also has ADHD and has been on Adderall since she was a teenager--I think those meds served to control her BPD symptoms, maybe masking the disorder. 
   So her behavior and life choices have been "normal" until the birth of her second child. This poor baby suffered from acid reflux for his first year, which was extremely hard on her--he was in agonizing pain so much of the time. Add to that stress the care of her other son, then almost 4, and the onset of COVID, which caused her acute anxiety--and having her husband working at home was difficult for her, he was underfoot and in her business.
   About three years ago, she started having these intermittent episodes of bizarre behavior. She would become hysterical or extremely depressed over minor issues, locking herself in a bedroom for hours. Some days, she'd become intensely stressed and overwhelmed by the same daily childcare and household management activities she'd handled fine the day before. And she became paranoid about her husband's work, friends, interaction with the kids.  Her treatment of him was so erratic--one day he was the love of her life, her Prince Charming, she absolutely adored him  The next she would become verbally abusive over some perceived trangression. It might be something as trivial as his tone of voice. She would demand to go through his phone, throw his clothes on the floor or in the trash. The idolize then demonize thing. But these episodes were short-lived, she'd always snap out of it and be the loving mother and wife for weeks at a time.  Her husband and I both thought her problem was hormonal, the episodes seemed to occur more frequently shortly before and during her period. Not the  case.
   Over the past month, she has escalated, the meltdowns have gotten worse. The most recent rants lasted for over two weeks and were the most severe so far. She took scissors to her husband's clothes, cutting up almost everything be owned. She texted an old boyfriend. She kicked him out of the house, then texted him in desperation three hours later, begging him to come back. She often tells me about her behavior, she doesn't hide it because she considers herself both rational and justified. While both she and her husband assure me that all this goes on after the boys are in bed, but I am extremely worried about my grandsons. Not their physical safety, she consistently adores her children and would never hurt them. I worry about the emotional toll on them, given the tension in the household.
   I go to a psychiatrist monthly for depression issues and have always talked about my daughter and my concerns about her marriage and children..the doctor has been sympathetic but unwilling to define her problem because he hasn't seen her. But after this last bout of extreme behavior, I went to him and pushed him hard for some kind of diagnosis. And he (reluctantly) suggested that her behavior sounded like Borderline Personality Disorder. Which I had only vaguely heard of and knew nothing about. So I hit the books and the internet.
   After many many hours of research, there is no doubt in my mind that my daughter has BPD. I shared my doctor's opinion and my research findings with her husband, he was blown away  We conferred on the nine symptoms and agreed that she is currently a definite yes on four of them, a strong maybe on two more, and a no on two.
   But..I'm thinking that if there is a BPD spectrum, she lands on the less severe end.  Because the explosiveness, out-of-control anger/hysteria/misery, property destruction, mistrust are ONLY directed at the husband. Never at her children, or me or her father--as I think back, there may have been a few attacks on her older brother as a teenager, but he was extremely mean to her a lot of the time. She has always had many close friends that love her. She is never impulsive, plans things out almost to the extreme. And she is definitely not a risk-taker, her fear of catastrophe and her concern for her boys' safety makes her very cautious.
   So what do I do now? This post is way too long and no one is going to read it, I don't blame you. Way too much background material when my only question is--do I tell her that she has BPD? She can't hear it from her husband, she can't know that I shared any of this with him--she will see it as  conspiring  behind her back and he will suffer the consequences. It has to be me, and it has to be up to her how much she tells her husband. But who likes to be told that they have a serious mental illness? She might accept it and maybe look into a treatment program. Or she may react with absolute denial (more likely)--she could be furious and turn on me, prevent me from seeing my grandsons. She has an online therapist who prescribes her ADHD meds, but I know for a fact that she never tells him about her "psychotic" behavior. Do I contact him, tell him what I've discovered, ask him him to evaluate her? Is that even ethical?
   Somehow she has to know that all the seemingly terrible things she's said and done to her husband have NOT been her fault. I want her to understand that her random loss of emotional control and her plunges into darkness are the result of an illness, not the deliberate choices of a "bad" person. And I have to apologize to her for being so oblivious to her disorder for all these years (hopefully without bursting into tears, I've cried too much over this).
I'm at a loss.  If anyone reads this and has a suggestion, I will be grateful beyond words. And if not, the writing down of everything has at least been therapeutic, maybe some answer will come to me from the cosmos.

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

[Leaf56]

Hi, I feel the need to stop you here before you possibly make a very big mistake with irreversible consequences. Others may disagree with me about what I will say now and that is their right, but I think you should think long and hard about your approach before you do anything at all.

You said: "Somehow she has to know that all the seemingly terrible things she's said and done to her husband have NOT been her fault."
They are absolutely her fault. If you suggest otherwise you're doomed.

You said: "I want her to understand that her random loss of emotional control and her plunges into darkness are the result of an illness, not the deliberate choices of a "bad" person."
BPD is NOT an "illness." It's a clinical description of a set of behavioral characteristics.

You said: "And I have to apologize to her for being so oblivious to her disorder for all these years."
No, you absolutely do NOT have to apologize to her nor should you. Her behavior and the responsibility for that behavior is hers alone.

And please don't feel the need to apologize for writing long posts. Everyone writes long posts here and everyone reads them. It's no big deal.

[fortwashington]

Thank you for reading my post, I hope you're still there--because all this is new to me, I'm clueless and confused. If I"m interpreting your response correctly, you're saying that she can control the emotional outbursts and irrational, destructive behavior--but chooses not to? And you say that BPD is not an illness, can you clarify that for me? Here's a quote from the National Institute of Mental Health, it says "Borderline personality disorder is a mental illness that severely impacts a person's ability to manage their emotions"--which says to me that BPD is a neurological disease, some glitch in the brain circuitry--and  the disease causes some or all of the nine symptoms. Is this wrong? If you have the stomach flu, vomiting is a symptom you can't control. Until you get treatment or the disease runs its course, you will vomit, like it or not. Maybe you're talking about therapy treatment for BPD, I've read that there are types of therapy that can help, that would give her tools to control her actions.  But she's not there yet, she doesnt even know that her behavior is symptomatic of BPD, much less that there is treatment available.So how can she be at fault? I can't imagine that laying blame on her is the right approach. Can you help me understand what you mean==

[Leaf56]

I didn't say to "lay blame on her," but I would absolutely hold her accountable for her actions.

Yes, she can control her emotional outbursts and irrational destructive behavior but chooses not to.

BPD is NOT an illness like the stomach flu (and just as an aside, I have a lifelong phobia of vomiting and am here to say that you can very much control vomiting. And while at first I thought that was beside the point, now I'm thinking that it is very much the point since you chose that as your analogous illness). Now, if you'd chosen cancer, well, then that would be another story. So, I believe that the only mental illness that is beyond the control of the afflicted is schizophrenia and possibly bipolar. And of course that is an opinion, but it is shared by many in the mental health field. All these other "mental illnesses" are really just names that describe sets of symptoms. Whether they are "glitches in the brain" is completely up to debate and entirely unproved. Best to approach this particular set of symptoms as not.

She MIGHT benefit from therapy. She also might not. Most don't. There is no magic pill. Don't hold out hope for one.

What should you do? At the very least get advice from a qualified professional. You and her husband are not qualified to diagnose your daughter with anything and so should not.

[fortwashington]

   Ok, I understand your point and it makes sense. But when she and I talk about what she's doing, I often bring up the possibility that her husband could reach the breaking point and file for divorce....and that she could lose custody of her children, the worst thing that could happen to her. Yet the episodes continue. So I'm not sure she really has that much control.
   Anyway, I appreciate your input and will give it a lot of thought. One question--you sound like you might be a therapist or mental health professional in some capacity  If so, can you advise me on the protocol for contacting her online doctor? Would it be a breach of confidentiality to email him about my concerns? And do you think he would tell her that he heard from me? That would be disastrous, not worth the risk. Thanks.
  Oh and by the way, you're right, stomach flu wasn't a good example, sorry.  But I'm pretty sure it's not the best idea to suppress vomiting, your body is trying to rid itself of something noxious/toxic. 

[Leaf56]

Oh my goodness, no, I am absolutely not a mental health professional of any kind. These are my opinions, and I acknowledge that many here would consider my opinions about "mental illness" as invalid. That said, the debate is a very real one. You can read the original academic paper on this topic here:

https://depts.washington.edu/psychres/wordpress/wp-content/uploads/2017/07/100-Papers-in-Clinical-Psychiatry-Conceptual-issues-in-psychiatry-The-Myth-of-Mental-Illness.pdf

And a layman type article on the debate here:

https://www.psychologytoday.com/us/blog/supersurvivors/201705/is-mental-illness-real

Why would you assume that the spectre of divorce and losing her children would be so strong as to mean that she would never behave in a way that would jeopardize her marriage or custody? That's a very big assumption. I mean, for all you really know, he's having an affair and gaslighting her and it's causing her to lose her mind about it. I'm not saying that's likely, just that it's a possibility. Only they know what's actually going on in their marriage. And she might believe she has a stone cold case for custody, and truth be told she probably does since she's completely reliable in every way except for in her relationship to her husband, which is kind of typical before a divorce. Maybe they will just get divorced and all this will be over?

One thing I do know about contacting her therapist is that generally it's not unethical to do so for the purpose of providing info to the therapist. It's a one-way street though. He can't say anything at all and may only listen to the info you want to provide if someone is in immediate danger. I had to do that with my son's care team. But, I believe he is obligated to inform her. If he's not obligated, I believe that ethically he should.

You are also correct about the stomach flu. Much better out than in! Wish I could, but I can't.

Also, if you wait a few days you will probably get other responses here that you like better than mine. I'd keep mine in the back of your mind though.

[kells76]

Hi fortwashington and welcome to the group   glad you found us. This is a place that understands the difficulty and confusion that can come with being the parent of an adult child with BPD.

It's good to hear that you have a psychiatrist -- when there's a pwBPD (person with BPD) in our lives, we need all the support we can get! Can I ask, are you in a relationship right now (married, other...?), and if so, how is your partner coping with your D36's challenges?

I hear you being concerned about the impact of the disorder on her own well-being and on her relationship with her husband. It makes sense that as a parent you feel the pull to do something, anything, to relieve your child's suffering, and you're wondering if telling her about your finding could help.

Like you mentioned, BPD can be considered a "spectrum disorder", as not every pwBPD has a diagnosis, or all the traits, or traits at the same severity level. For example, my husband's kids' mom has many BPD-type traits and behaviors, though no diagnosis, and she is not physically violent or abusive, or doing drugs or drinking excessively. Her traits show up as relational manipulation.

Both the NIH and the NEABPD (National Education Alliance for Borderline Personality Disorder) are reputable organizations for learning more about BPD; the NIH may lean more clinical, while NEABPD is very focused on how family members can work on more effective communication and skills with a loved one with BPD. Dr. Marsha Linehan, who was involved with creating DBT (a well known therapeutic intervention for BPD), worked at the University of Washington , so they have a strong DBT research and practice program there. Could be great resources.

In fact, as you think through what you want to share with your D36, you might check out the NEABPD's "Family Connections" program. It's a free, remote 8 to 12 week program that educates family members about what BPD is and how to have better, more effective collaborative communication with your pwBPD. Take a look and let us know if you think it could be helpful.

As BPD has a big shame component, and tends to impact the closest relationships the most, it can be difficult for pwBPD to hear, process, and take in shame-inducing information from a loved one. I think you're right that your D likely won't be able to hear much from her H right now, so it makes sense that you're curious if you are the right person to tell her.

It's hard to say -- maybe you are, maybe you aren't -- but what does make sense to me is that even if you aren't the right person to suggest it to her, you still have a role to play in her life, modeling support, empathy, and steadiness.

...

Lots of food for thought there, so I'll wrap up for now -- just one more question, to get a better sense of your situation: how is your relationship with her boys right now? Do they come over frequently, do you go over there frequently, are things pretty positive between you and them?

-kells76

[Sancho]

Hi Fortwashington.
First of all, the background information is really helpful - sometimes responding can be difficult when you don't know the history or details of what is happening.

In my opinion I certainly would not tell dd that she has BPD for a few reasons:
- you mention these symptoms started about 3 years ago is that right? That would be when the younger child was about 2 and after a really, really difficult time in his infancy. I feel that BPD signs would have appeared earlier.
- yes there sure is a spectrum, but from your perspective dd only definitely meets 4 criteria
- the all good/all bad targeting of the husband is typical but there could be other explanations.
- many bpd symptoms are not within the individual's capacity to completely control without effective treatment, so just telling her doesn't mean that dd is able to control the mood swings
- it is taking a big risk when you don't know for sure that dd has this serious illness.

But where do you go from here? Dealing with this situation is very difficult. The fact that you are not targeted and the children aren't also is very helpful. Protecting this is really important. The fact that the husband talks to you is fantastic. You can't solve it for him but he has your support and understanding so you both know you are not alone.

I'm just going over things in my mind here . . . .DD IS diagnosed with ADHD and has been treated for many years - and it sounds that treatment has worked. After the birth of the younger child and dealing with that for a couple of years the wheels fell off and DD is in this state.

I am wondering if a combination of intense anxiety/stress on top of the ADHD is one possible explanation? Given the mood swings I wonder if early onset menopause could be another?

Does dd have a GP that she sees regularly? I understand client confidentiality but I am wondering fi you or her husband would be able to talk to them? I think a thorough physical check up would be a good starting point - but how to get dd to that?

I support some people who I am not related to and in the past when I have had concerns I have approached their GP and said 'I know you are not able to talk at all about xxxx, but I would like to have a one way talk in which I give you some information because I am very concerned. I would like this to be in confidence - is that okay, because I probably prefer not to say anything if you are not happy with it being in confidence.

I have found this has worked. I just give some details of what concerns me and leave. It certainly would be possible for her husband to talk to his GP about what is happening

This might not be possible.

The situation is very difficult and you would like to get some help into it asap. However I think 'if in doubt, don't'. So while you are unsure about what to do try to think of any/all options that could be possible.

Another way into the situation might be for the husband to say to dd 'I am struggling with out relationship at the moment and I think it's a good idea for me to get counselling'.

I was once in a situation when I was in considerable danger and I worked with a counsellor to create a plan that resulted in the person becoming engaged in therapy.

Lots of thoughts going through my head here . . . . .

Hope you can post again to let me know if you think there are options for getting some help into the situation.

[SaltyDawg]

DO NOT SHARE WITH YOUR DAUGHTER ABOUT DIAGNOSIS OF BPD - it will backfire - this should come from a licensed professional, and then most will not diagnose (they don't want the person with BPD to run).

I won't duplicate what others have said, but I agree with all what has been said.

Buy/Borrow the following book and read Section 1 immediately, also share it with your daughter's husband, it has an excellent assessment tool in it.

Stop Walking on Eggshells: Taking Your Life Back When Someone You Care About Has Borderline Personality Disorder 3rd edition (older edition don't have this tool) by Paul T. Mason and Randi Kreger

My wife had all 9 symptoms and sub-symptoms except the sub-symptom of "self-mutilation" (part of the suicide symptom) so it was easy to identify.

Which of the 4 symptoms do you agree she has, and which of the two are 'maybe'? 

Keep interacting with people on this board, and they each have gone through their own version of this living hell with their loved ones whether it is a partner, parent, sibling, child, or friend.  The disorder can present in many different ways (theoretically 256), and it is not a one size fits all solution.  Often BPD is comorbid (exist simultaneously) with other mental health issues.  For my wife it is both OCPD and BPD.  I can deal with the OCPD, but not the BPD.  My wife's OCPD (baseline, this is my wife's 'normal') has masked the symptoms of her BPD (triggered when stressed by anything that gives her anxiety, which includes me).

The book I just mentioned was written by experts on the topic, and it will give you a good introduction on BPD.  Read it, and ask questions here.  It was the 3rd one I read on the topic, but it should have been the first.

[SaltyDawg]

I negelected to mention, this is all so stressful to you and your D and SIL.  Make sure you do some self-care, whatever that may look like to you.  You need to fill your cup in order to help your daughter and SIL through this ordeal.  You can't help them when you are out of energy.

Take care, with self-care.