What do we do?

[WhyHerWhyUs]

We are so lost

My daughter with BPD (24) is in a city about a 2 hour drive from us. She is causing all sorts of problems there - starting fights, harassing other tenants and the building staff. She had roommates but all have moved out because of her.  The police have been called and they don't do anything. She is violent with us, so she can't live with us. She gets money from the government for food and we pay her rent. We get calls and texts at all hours of the day and night demanding money for food (she has likely used the government money for weed and alcohol). We don't answer those calls. We don't answer any of her calls. She is clearly in a bad place and needs serious intervention, but she won't call herself and no one we have called (mental health orgs, crisis lines, etc.) will help unless she initiates the action or is currently expressing suicidal intention (she has, but not to us). I reached out to her by text, gave her the numbers to call and asked her to submit to voluntary admission to a psychiatric facility. This enraged her and she refused.

She's an intelligent girl with an undergrad degree, but she hasn't been in school for 6 months, has no job, and no friends. She sleeps all day, her room is atrocious, and she won't even make a phone call to arrange for the therapy we keep saying we'll finance. We were all she had, and that made us feel guilty for the longest time which means we enabled her horrible behaviour for longer than we should have. Her violent outbursts, false accusations of abuse, and mistreatment of everyone in the family have caused us to keep our distance from her.

We don't know if we're doing the right thing. I know she's an adult. I know she needs to hit rock bottom, but how deep are those rocks? And when she gets there, then what?

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]

Hi Why,

I’ve been right where you are now and it’s awful, between the worry, fear and desperation. You think you’ve tried everything and yet still see your beloved daughter is miserable, while incredibly, stubbornly stuck. Meanwhile she blames you for her problems.

I think you’re doing the right thing by protecting yourself from her abuse and being cognizant of enablement, which only serves to prolong the dysfunction. It doesn’t sound good that she’s self-medicating with booze and/or pot, as I saw how that made behaviors much worse for my diagnosed stepdaughter. She became very paranoid and sometimes lost touch with reality when using marijuana.

Though your daughter has been abusive to you, she knows you’re all she has right now. Don’t take the insults and lies personally, that’s just BPD talking and distorting facts. If anything, take it as a sign that your daughter is dysregulated.

I’d advise to keep the lines of communication open. If your daughter screams at you, you can hang up, but at least you know she’s alive. You can offer to help her get help. But you don’t support her buying illicit substances. If she asks for money for food, maybe you deliver food right to her, or you invite her to have dinner at your house. But if she’s abusive, you show her the door.

You ask, what is the bottom?  In my stepdaughter’s case, it was pretty bad. She dropped out of school, couldn’t stay in a job more than a day or two and lost all her friends. She lived like a slob. She slept all day and was up all night consuming social media. She was cut off from all her family except her dad who gave her money. Her hygiene was poor. She attempted suicide a few times. BUT the suicide attempts got her in the hospital for treatment. And maybe she had to hear it from « professionals » instead of parents that she was unwell. At some point she had to realize that the current situation wasn’t working for her, and it was time to try something different. Fortunately she’s in a better place now.  And she was about your daughter’s age when she hit bottom.  She’s young enough to turn things around and not let the « bottom » derail her entire life. But the timeline is up to her, provided you don’t extend it through enablement. Look, it sounds like your daughter has a lot going for her. She finished school and has loving parents. She must know this and has plenty to be hopeful about. She just can’t see it right now in her dysregulated state.

[BPDstinks]

hi!  i am so sorry you are going through this!  My 24 y/o BPD daughter cut ties with me, her father, sister & beautiful nieces a year (and 1 month) ago...it is very sad & trying, and, like you, I wonder "what happens when she wants to "re-join?" other than her father & I, who will care or notice?  I still cannot wrap my brain around it; she is the first thing I think of in the morning & last at night; she will text sporadically, however, I am just lying low at this point; i wish you peace and good luck

[WhyHerWhyUs]

Thank you both for your responses. It's really helpful to hear from someone who is on the other side of this and comforting to know we're not the only ones experiencing the despair and pain.

The thing I can't wrap my head around is what happens when the person with BPD admits they need help? For example, do they need an intensive in-patient program to kick start the process, or will weekly/biweekly therapy and a desire to change be what they need? I'm sure it's different for everyone, and the path is not linear, but I'd love to know how treatment starts and progresses.

[CC43]

Oh Why,

You ask, what happens when a person admits they need help?  I'm sure everyone's case is unique.  But admitting that something is wrong, or isn't working, conflicts with their negative world view and victimhood status.  People with BPD spend most of their time and energy blaming OTHERS for their problems, probably because admission that they themselves have issues is incredibly painful.

Maybe they have tried therapy, but if they feel coerced to do it, the therapy won't work in my opinion, because therapy IS work.  My stepdaughter just "went along" with therapy for a few years, often skipping the expensive sessions, and she didn't make any progress.

However, when she hit bottom a couple of times, I think she finally came to the realization that, basically, it was therapy or death.  And she had to find INTERNAL reasons for living, i.e. hope for a future, which was probably very hard to see in her dysregulated state.  My husband basically had to give her an ultimatum:  if she wanted his financial support, she had to get therapy, or she was on her own.  By that time, her choice was easy.  But without the ultimatum, and with financial support without stipulations, she probably would have continued to wither away, self-medicating with marijuana.

What therapies did she try?  I guess the question really is, what therapies didn't she try?  She had several hospital stays after suicide attempts, of about a week each time.  She attended a live-in program at McLean.  She's been seeing a therapist for years.  She's had online DBT classes.  She attended in-person and online classes with other patients trying to re-integrate into adult life after a mental health hiatus.  Some programs didn't work, basically when she didn't have the right mindset of truly wanting to get better (i.e. when she felt coerced).  But when she had the right mindset and parental support, she did better.  There were setbacks, but I'm very pleased to say that she's on the right track now.

I think the keys are (i) her hitting bottom and admitting that she has a problem; (ii) having loving parental support; (iii) finding a therapist that she trusted; and (iv) finding the right medications to treat common co-existing issues (e.g. depression/anxiety/mood stabilizers).

Other factors that helped were insisting that she live closer to home, where her parental support system was.  When she lived far away, she was making terrible decisions because she wasn't of a right mind, and she was too far away to keep tabs on.  In addition, a critical turning point was when she authorized her therapist to share information with her dad (my husband).  BPD is tough to manage, and having ongoing parental support and guidance to help her get "established" as an independent adult is important.  (My stepdaughter had tremendous difficulties adjusting to college and work life, which is hard for normal people but tremendously difficult when dealing with BPD.)  In addition, I think it's important to advance in baby steps.  At first, simply going to therapy each week was an accomplishment.  Then a finding a part-time job and sticking with it.  Then finding some roommates and getting settled in an apartment.  Then a taking a class online. 

[CC43]

Hi Why,

I'll just add some thoughts about getting help.  I think it might backfire if you tell your daughter that she ought to see a therapist because she isn't well, or because she has problems, even if that's entirely true.  I think people with BPD are convinced that others are the source of their problems, and they re-interpret past events with that lens, no matter how misguided or warped that is.  Why do they do this?  Because it's too painful for them to deal with taking responsibility for their dysfunction.

Has your daughter accused you of being abusive, evil or psycho?  How did you feel when she said those things?  If you're like me, maybe you felt terrible, and wondered if you really were the one to blame.  And then maybe you felt defensive and offended and angry.  I bet that's exactly how she feels when others suggest that something's wrong with her.  And then maybe you realize she's just projecting her disordered thoughts about herself onto you.  It's so exhausting, right?

Maybe an approach is to focus on the positive and not the negative.  By that I mean, avoid suggesting that something is wrong with her, and focus on trying something different to improve her situation.  What does she have to lose?  Wouldn't she want to try to feel more hopeful, rather than feeling miserable or so upset with everyone else?  If "everyone else" is the source of her problems, maybe a therapist could help her process the situation and cope better?

In my stepdaughter's case, when one expert therapist diagnosed her with BPD, she disagreed (even though she had almost all of the symptoms), and she alleged that therapist was terrible.  But I don't think that the "label" or the diagnosis is as important as the plan for treatment.  For my stepdaughter, that included taking prescribed medications, having some joint therapy sessions with her father, and doing some residential, in-person and online therapies over the course of a couple of years.  The plan also included staying away from marijuana, but she had to hear it from a doctor to understand that marijuana made her worse, not better.  The good news is that she recently reduced the frequency of therapy sessions, because she has been doing better--but she still needs that regular support.

A turning point for me personally happened when my husband nearly had a breakdown, reeling in despair from the latest suicide attempt.  Before that, he was very resistant to my suggestions about a course of action, as he took any suggestions from me as an indictment of his parenting and as criticism of his daughter.  But when he had that breakdown, I thought I had a window of opportunity to say one sentence.  I suggested that his job at that moment was to get his daughter into treatment, and to ensure that she did whatever the doctors--the experts--recommended.  You see, in the past, my stepdaughter would skip sessions or decline to enroll in a suggested program, because she wanted to do other things at that moment.  And by following the doctors' recommendations, my husband could relieve himself of the burden of coming up with a solution--because nothing "normal" that parents do ever seems to work with BPD.  (BPD is definitely complex and requires specialized skills/experience that we just couldn't implement effectively.)  It was a straightforward plan:  he would support his daughter getting therapy and doing whatever was recommended, so that she could get back on track, or else she would be on her own.  That shifted the focus of conversation away from her faults and poor behavior, and towards an action plan, where she retained "control" through making her own decision.  Since she had hit bottom, and she was completely dependent on her dad, I think the decision was easy.

I know you must be reeling and hurting right now, and it is awful to watch your daughter self-destruct while feeling so helpless.  But maybe if you tweak the way you frame the issue and the way you provide support, she might decide that she has self-worth and she deserves to save herself.

[WhyHerWhyUs]

Thank you so much. We had a better weekend. My husband started being the point person for communication (it has always been me) and that seems to be working for her at the moment. We have taken your advice and read a lot of the articles on this website to open up communication in a way that doesn't upset her or make her defensive. Cannabis is definitely an issue - she just recently started up again when she had been off it for almost 2 years. Those 2 years were so much more manageable than what we're dealing with now. We're emphasizing the need for her to be healthy and productive and just not reacting at all to the anger, blaming, and delusional things she says.