18yo Stepdaughter- questions

[WorriedStep]

Hi all,

I just wrote a lot on an intro post, but here are some questions I’m looking for input on.

BACKGROUND
My stepdaughter lives with me and her Dad full time and has since she was four. Up until the start of this school year, she’s been a sweet, fun kid that had and kept friends and jobs, managed her calendar, did her schoolwork and mostly got A’s and B’s, played on sports teams and did pretty well. She’s had a therapist since age 14 - she has a difficult relationship with her bio Mom and we knew there was tough stuff there.

This year is senior year of high school.

In August of this year she started crying almost everyday at dinner. Sometimes she could give us a reason why and sometimes she couldn’t. Often it felt like the tears came first and the reason she offered was something she was trying to make match the tears. At her request, we made an appointment with a psychiatrist. The first one really didn’t work out; the second one we were able to see in January- by that time we were in full crisis.

She had a very intense, attached at the hips boyfriend from October- end of December. In this time, the crying continued, and we kept having more and more crises- reasons my husband and I had to suddenly change plans and pick her up or go to her. She talked more and more about us “kicking her out” - not something we’ve ever threatened. Her moods changed incredibly fast- one day I watched her go from “this is a great day” to tears in about 3 minutes with nothing external changing.

Breaking up with the boyfriend (he dumped her) made everything much worse. The psych said “traits of BPD” and started mood stabilizing meds. She seemed to keep going downhill and was obsessed with the (now) ex-boyfriend. She totaled her car. At school she made a (false) highly serious legal accusation. At the end of Feb we entered her into an IOP and that seems to have stabilized things somewhat. (She’s not doing well- still failing classes and not taking initiative in her life, but she’s not doing as badly).

QUESTIONS:

- She seems to have lost so much cognitive ability and executive functioning. It’s shocking to me. Do you all think it will come back?

- For years I was very comfortable around her and considered her my daughter. As this year has progressed, I’ve gotten more and more uncomfortable around her. I have a big “what next??” fear. We used to have good, heart to heart talks and it seems that I can no longer do that with her- she shuts down our matter she claims that I said very different things than what I actually said. I struggle with small talk. Do you all relate to feeling this uncomfortable? Do you have suggestions?

Her older sister had a hard senior year too- in hindsight, it is likely also BPD. Self harm, drug use, and an eating disorder. That child, now 22, is not functioning as well as she was her junior year in high school, but is doing better in the ages 20-22. We didn’t get her into an IOP (we should have but didn’t know it was a possibility) and she continued downhill for about 2 more years, but has been improving for the last two years. She hasn’t gone back to college but is at least holding a job and an apartment.

- Will the youngest likely follow a similar path?

I send care to everyone here. This illness is mind boggling and heart breaking. I hate that we have a reason to be here.

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

[CC43]

Worried,

Your story and mine have many parallels.  I have a stepdaughter in her mid-20s diagnosed with BPD.  She has an older sister, who has mental health issues as well.  I'm their stepmom, and I've know them since their early teens.  However I didn't get married to their dad (who had been divorced for over a decade) until all the kids had graduated from high school, basically to minimize disruption to the kids' lives.  Little did I know that my life would become highly disrupted because of the emergence of mental illness.

Their mom is a high-conflict person, and the relationship with the girls has had many ups and downs.  Basically, the second I got married to their dad, the eldest daughter had a suicide attempt and moved in with us (previously she was enrolled in college).  I think that suicide attempt became contagious.  Almost like clockwork, when the younger daughter hit the exact same age in college, she also attempted suicide, followed by withdrawal from school and moving in with us.  I can't help but wonder if she felt "entitled" to a year "off," just like her sister.  Both the girls, alienated from school and friends, suffered a downward spiral of depression, acting out and disruptive behaviors.  The eldest, who is outgoing and energetic, pulled herself together, embraced therapy and got back on track within a year to 18 months.  However, the younger daughter, who is generally avoidant and passive, languished for YEARS.  She was ultimately diagnosed with BPD.

During her hiatus from life, my diagnosed stepdaughter was much less functional than she was in high school.  In fact, she was less functional than a kindergartener.  Kindergarteners manage to attend school, eat with the family at mealtimes, pick up their toys and play with friends.  My stepdaughter couldn't manage any of those things when she was untreated.

I think that the core of BPD is emotional dysregulation.  A disappointment, slight, criticism, rejection or any number of triggers will provoke intense, negative feelings, and she just can't handle them.  When that happens, the logical part of the brain recedes to the background, and the emotional part takes over.  And she can't seem to calm down and get back to baseline; rather, I think she re-plays negative scenarios in her head, feeding the fury.  Her emotional reactions, often to mundane events, are super-sized.  I think her brain is so consumed by these thoughts that they crowd out everything else, and it becomes impossible for her to focus on anything else.  The only thing she seems able to do is to distract herself with the phone or TV.  But then she'll bail on planned activities, give up on her studies, and feel left out on social media, making her situation even worse.  Then she'll lash out at her family, blaming them for her plight.  She will re-cast history and twist facts to portray herself as a victim.  She clings to victimhood status like her life depends on it.  Because it's much easier to blame parents than take responsibility to change for the better.  So to answer your question, does BPD affect cognition and executive function?  I'd say, yes it absolutely does, because the emotional brain crowds out logical thinking and planning, and it even warps facts to match feelings.  Behaviors resemble "adult tantrums."

Both girls used marijuana, and in the case of the stepdaughter with BPD, I think it made her situation much, much worse.  I suspect it fed her bouts of paranoia, and it "enabled" her to tolerate lying in bed alone for months.

My stepdaughter had to hit bottom before taking therapy seriously.  Her bottom included a fourth suicide attempt, losing every single friend and alienating the entire immediate and extended family except her dad and me.  The upshot is that now, with therapy and adherence to medications, she's doing a bit better.  She still has ups and downs, but she's headed in a better direction overall.  To answer your other question:  is it possible for a person with BPD to regain cognitive and executive function?  I'd say, yes (for the most part), if she embraces therapy to change for the better, stays away from mind-altering/illicit drugs and is compliant with prescribed medications.  But she's still beset by emotions and impulsive reactions from time to time.

You ask, what's next?  Based on my experience, I'd say it will help if you and your husband have a unified view of the situation.  I would caution against enablement of self-destructive behaviors.  That means rescuing your stepdaughter from facing consequences of her own poor choices, allowing abusive behavior in your home and enabling her to resist treatment and medications (if any).  I think my stepdaughter was allowed to wallow, checked out of life while making the household absolutely miserable, for far too long.

You notice that it seems difficult to talk to your daughter these days.  I'd say, it's almost impossible to talk rationally with a person with BPD when they are emotionally dysregulated, because they are overtaken by negative emotions.  You might have to wait until she calms down.  This could take weeks, in my experience.  I call these periods of isolation "adult time-outs."

When I heard the BPD diagnosis, I had no idea what it was, but when I read about it, I felt it fit 100%.  In my mind, the good news was that it's treatable, so there's reason for hope.  The key seems to be that the person with BPD needs to want to change to get better.  Otherwise, the therapy doesn't work well in my opinion.

[Ourworld]

Hi Worriedstep,

Try not to enable or accept her negativity, just ignore and speak to her as you did when she acted ‘normal’, it hasn’t been that long, that intelligence should still be in there. (this worked with my daughter)
I’m thinking that once the younger daughter graduates high school perhaps she will begin to realize that her life is going nowhere.

She has to come to the realization that she needs treatment to get better and this is only a possibility if she has to face her fears and hit rock bottom.
This is less likely to occur if anyone recognizes what she says or how she acts. You just have to use tough love, and don’t  engage her non-sensational accusations.
I did not even think about my daughter having any BPD issues that I have learned about now. When my daughter was a teenager, if she cursed or raised her voice to me, I would tell her that she could not talk to me like she was talking to one of her friends.
By this time I was a single Mom since my husband left and passed away when she was only 11. But this worked for me, she rarely acted out around me, and showed good respect. Since then, I have been told of her irrational behaviors with her ex-husband and friends-I felt so bad for them.

I don’t know for sure if that is something y’all can do, but if possible, it would be worth a try to see if she’ll self-soothe and take back responsibility for who she is.
This kind of makes me think about when a baby starts sleeping in their own room you have to be strong and let them cry it out-but you still take care of them and give them love and trust.

When my daughter went to college she had her first attached boyfriend, she moved in with him, then about a year later he brought in another girl. She was devastated and it just made things worse for her, she ended up getting pregnant 6 months later by someone she was taking home after a party. After the boyfriend fiasco, said she was ready to go back to school, and I did not realize how messed up she was. She told me she was giving up the baby for adoption because she wanted to finish college and it wouldn’t be fair to me.
This shows the respect I have from her; she ended up cutting me off 7 years later but that was because she didn’t want me to see how crazy she had become, this actually happened after I returned from living/working overseas for a few years after she graduated and was living with her fiancé, because I still did not realize her problem.

It does hurt,  but at least I can happily live my own life and don’t have to constantly still be running to take care of my adult child, I find peace with lots of prayer!

But this kind of respect is what you want if possible, her brain may get messed up, but I believe her intelligence is still there, just be loving but use some tough love to see if that helps.

Remember; when any hurt or negative thoughts creep into your mind to make you feel sad or guilty in anyway; those thoughts are NOT from God, ask him to take them away and fill you with His peace.

I wish you the best, OurWorld

[WorriedStep]

Thank you both- it really helps to interact with people that understand.

The idea that she has to hit rock bottom and decide she needs help keeps coming up. It makes sense and at the same time it feels so awful. I guess I don’t really have a question… just stating my feelings.

[CC43]

Worried,

It's totally understandable that you feel awful when you see a loved one suffering!  Of course you want to make your family happy and support them through tough times.

In my experience with BPD, a key issue is the victimhood mentality.  If you read these boards, you'll see that a typical behavior pattern is for the child to blame parents for everything that goes wrong in life.  It may be that they feel compelled to blame parents, because accepting responsibility--for acting badly, for making a bad decision, etc.--is just too painful, given their emotional dysregulation.  Another behavior pattern is to twist facts, in order to cling to victimhood status.  It sort of makes sense--blame someone else, and expect everyone else to change to make life better!  The worse the tantrums and the self-harming behaviors become, the more parents can bend over backwards to try to make things better, out of guilt, pity or both.  But this usually serves to make the deleterious behavior worse.  Because the person who needs to change (and face reality) is the one with BPD, not everyone else.  But to realize this is probably painful, and it probably makes things worse for a while.  That's why it seems a bottom must be hit.